Some 2019 CPT® and HCPCS Code Changes

With 335 CPT code changes and other HCPCS changes for 2019, here’s what you need to know.

This blog was originally published on January 30, 2018 and was updated on December 14, 2018 to reflect coding changes.

On September 5, 2018, the American Medical Association (AMA) released the 2019 CPT Code Set in an official press release. With 2019 just around the corner, this is a good time to understand what has changed and how it may affect your medical practice moving forward.

Based on the comments from AMA President Barbara L. McAneny, MD, here are some of the overall themes to note with the changes made for CPT codes as we head into 2019.

• Many of the changes reflect new technological and scientific advancements
• Updates reflect the ability to better share information efficiently and accurately across the medical community
• Overall, CPT codes serve as a common language for reporting current procedures.

These category 1 CPT code changes will take effect for reporting as of January 1, 2019.

Jordan Miller, MD, senior medical director of dermatology, advised that, in 2019 many new CPT and ICD-10 codes will go into effect. The biggest changes for Modernizing Medicine dermatology clients will revolve around these new, specific biopsy codes:

• Tangential biopsies (11102 and 11103)
• Punch biopsies (11104 and 11105)
• Incisional biopsies (11106 and 11107)

While almost all of these changes will occur on the backend in our EHR system, EMA™, and have no impact on the provider’s documentation, users should be aware of a few new plans:

• If you perform a biopsy for tissue culture there are now two new plans, Shave Biopsy for Tissue Culture and Punch Biopsy for Tissue Culture, which were created to account for these new codes. The old plan, Biopsy for Tissue Culture, will be sunset because it was not specific enough.
• The new plan Incisional Biopsy will allow you to bill the 11106 and 11107 series of codes. Incisional biopsies are biopsies which sample the full thickness of a lesion without attempting to remove the entire lesion. Incisional biopsy codes also include the layered closure of the wound if required.

Detailed below are some of the 2019 CPT and HCPCS code updates for the respective medical specialties that will be reflected in EMA.

Dermatology CPT Codes

Dermatology HCPCS Codes

Ophthalmology CPT Codes

Ophthalmology HCPCS Codes

Orthopedic and Pain CPT Codes

Orthopedic and Pain HCPCS Codes

Otolaryngology (ENT) CPT Codes

Otolaryngology (ENT) HCPCS Codes

Plastic Surgery CPT Codes

Gastroenterology CPT Codes

Gastroenterology HCPCS Codes

Urology CPT Codes

With Modernizing Medicine’s electronic health record system, EMA helps suggest automated codes based on what the provider documents in a visit to reflect the 2019 CPT and HCPCS changes.

Please note that this is not intended as a comprehensive list but a quick reference guide for some key 2019 CPT and HCPCS codes for the selected medical specialties. Please refer to the American Medical Association (AMA) for all CPT Code Changes.

Sources

• American Medical Association (AMA). AMA releases 2019 CPT code set. https://www.ama-assn.org/ama-releases-2019-cpt-code-set. Published September 5, 2018. Accessed December 10, 2018.
• American Medical Association. CPT Changes 2019: An Insider’s View. American Medical Association. Published November 10, 2018. Accessed December 10, 2018.
• Centers for Medicare & Medicaid Services (CMS), HHS. Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; Medicaid Promoting Interoperability Program; Quality Payment Program-Extreme and Uncontrollable Circumstance Policy for the 2019 MIPS Payment Year; Provisions From the Medicare Shared Savings Program-Accountable Care Organizations-Pathways to Success; and Expanding the Use of Telehealth Services for the Treatment of Opioid Use Disorder Under the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. https://www.federalregister.gov/documents/2018/11/23/2018-24170/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions. Published November 23, 2018. Accessed December 10, 2018.
• Grider, Deborah. AMA Releases 2019 CPT® Code Set. https://www.icd10monitor.com/ama-releases-2019-cpt-code-set. Published September 10, 2018. Accessed December 10, 2018.

A Quick Guide to Some Key 2018 CPT Changes

A new year often brings new changes. One such change includes 2018 CPT® codes.

On December 31, 2017, the Modernizing Medicine team updated the smart billing engine in our electronic health record (EHR) systems, EMA™ & gGastro™ to reflect the 2018 CPT changes. Patient visits finalized on or after January 1, 2018, will reflect the 2018 CPT codes on medical billing insurance claims.

There are a total of 314 code changes throughout the 2018 CPT manual:

• 172 of these CPT codes are new
• 60 codes are revised
• 82 codes were deleted

As for the changes, they vary based on specialty.

Dermatology/Plastic Surgery CPT Changes: PDT and Facial Flap Repair

Photodynamic Therapy (PDT) is commonly performed to treat conditions such as actinic keratosis, acne, inflammatory rosacea and other skin diseases.

Two new PDT CPT codes were created, 96573 and 96574, and the existing CPT 96567 was revised. According to the AMA, the rationale behind the change relates to the physician-work component of each CPT RVU (relative value unit). Now the codes reflect the physician identification, application of the photosynthesizing agent and whether the debridement of a hyperkeratotic lesion occurred on the date of service.

Below is the description of the physician-work component included in each code:

• 96567: “Performed by Nurse, MA or Aesthetician”
• 96573: “Performed by MD, PA-C or NP”
• 96574: “Performed by MD, PA-C or NP with Pre-Procedure Debridement of Hyperkeratotic Lesions”

In 2018 we say goodbye to the deleted CPT 15732, a muscle, myocutaneous or fasciocutaneous flap of head and neck. 15732 splits into two new CPT codes to provide clarification on flaps with no named vascular pedicle vs named vascular pedicle.

• 15730 – “Midface flap without a named vascular pedicle”
• 15733 – “Muscle, myocutaneous, or fasciocutaneous flap of the head and neck with named vascular pedicle”

Ophthalmology CPT Changes: VEP

When it comes to ophthalmology, the new CPT code 0464T was created to perform Visual Evoked Potential (VEP) testing on glaucoma patients. Consequently the existing CPT code 95930 was revised to exclude glaucoma. No changes were made to 0333T which is used to test visual acuity during computer automated visual acuity screening.

Orthopedics/Interventional Pain/ENT CPT Changes: Chest X-Ray Interpretation

For Orthopedics, Interventional Pain and ENT practices, all nine of the 2017 Chest X-Ray Interpretation CPT codes were deleted and four new codes replaced them in 2018.  

The 2018 CPT codes are as follows:

• 71045: Chest, single view
• 71046: Chest, 2 views
• 71047: Chest, 3 views
• 71048: Chest, 4 or more views

Specifically for Interventional Pain practices, the International Normalization Management (INR Test) related to anticoagulation management, CPT codes 99363 and 99364 were deleted in 2018 CPT changes. They have split into two codes to differentiate if the management is occurring at home or outpatient.

• 92792 – “Outpatient”
• 92793 – “Home”

Gastroenterology CPT Changes: Anesthesia

GI sees big changes in Anesthesia related endoscopic procedures. In 2017 there was only one CPT for upper GI endoscopic procedures, 00740, and only one CPT for lower GI endoscopic procedures, 00810. Both 00740 and 00810 have been deleted in 2018.

The new upper GI codes describe upper endoscopic procedures vs endoscopic retrograde cholangiopancreatography (ERCP). The lower GI procedures differentiate between screening colonoscopies vs diagnostic/therapeutic lower endoscopic procedures. There is also a new code to report when both upper and lower endoscopic procedures are performed in the same session.

Here is a list of the 2018 Anesthesia CPT changes:

• 00731 – Upper GI – endoscope, proximal to duodenum
• 00732 – Upper GI – endoscope,  ERCP
• 00811 – Lower GI – endoscope, distal to duodenum
• 00812 – Lower GI – endoscope, screening colonoscopy
• 00812 – Upper and Lower GI – endoscope, both proximal to and distal to the duodenum

ENT CPT Changes: Balloon Sinus Dilation and Endoscopy

The existing balloon sinus dilation CPT codes from 2017 remain the same in 2018, but there is the addition of 31298 for when dilation is performed on the frontal and sphenoid sinus ostia.

There are two new Nasal/sinus endoscopy codes in 2018:

• 31241 – Nasal/sinus endoscopy with ligation of sphenopalatine artery
• 31254 – Nasal/sinus endoscopy, surgical with ethmoidectomy; partial

In addition, the 31200 section has many new instruction notes regarding the reporting of codes in conjunction to one another. There are also new modifier guidelines for modifier 52 and modifier 53 on endoscopy codes 31241-31235.

For EMA and gGastro users, the most specific 2018 ICD-10, CPT codes and modifiers will automatically generate medical codes in real time. CMS guidelines have been applied to our smart medical coding engine which can assist with clean claims and faster insurance payment. Overall this can help bring efficiency to your practice.

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Please note that this is not intended as a comprehensive list but a quick reference guide for some key 2018 CPT codes for the selected medical specialties. Please refer to the American Medical Association (AMA) for all CPT Code Changes. Another good source includes CodingAhead.com which lists new CPT codes as well as deleted CPT codes.

Sources

Breaking news: CPT 2018 update delivers 4 new E/M codes, mass revisions and updates. PartBNews. https://pbn.decisionhealth.com/Blogs/Detail.aspx?id=200623. Accessed January 8, 2018.

CPT 2018 Changes: An Insider’s View. American Medical Association. Accessed January 11, 2018.