Written By: Toni Elhoms, CCS, CRC, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer
Director of Coding/Compliance
It’s that time of the year again! The new 2019 CPT code changes took effect January 1st. Understanding the myriad of upcoming changes is crucial to obtaining the proper reimbursement for your services! The changes for 2019 address a number of interrelated issues. The AMA updated 335 codes to reflect scientific and technological advances in various services including medical, surgical, and diagnostics. Several additions reflect the real possibility of expanding coverage for connected health tools and other new delivery systems to improve healthcare quality. There were many code revisions with guideline, description and instructional note changes. CPT 2019 offers changes that affect nearly every specialty.
*Please note, this article is not an all-inclusive list; review your 2019 CPT book for complete descriptions of all changes. Appendix B of 2019 CPT provides a summary of additions, deletions, and revisions. — Click here for more information
Also, CLICK HERE to review the final rule for the 2019 Medicare Outpatient Prospective Payment System (OPPS).
Highlights of the most significant changes:
- Exciting new opportunities for telemedicine expansion and coverage
- These new codes reflect the key role non-verbal communication technology plays in care coordination between consulting and treating physicians, according to the AMA.
- CMS will pay for 2 newly defined physicians’ services furnished using communication technology
- HCPCS Code G2012 – Virtual Check-In
- HCPCS Code G2010 – Remote Evaluation of recorded video and/or images submitted by an established patient
- 3 new codes for remote chronic care patient monitoring services
- New CPT codes 99453 and 99454 should be used to report remote physiologic monitoring services during a 30-day period.
- CPT code 99457 requires live, interactive communication with the patient/caregiver and 20 minutes or more of clinical staff/physician or other qualified health care professional time in a calendar month.
- 2 new interprofessional internet consultation codes
- New codes 99451 and 99152 should be used to report assessment and management services. The codes are based on medical consultative time.
- 2 new codes added to the Ophthalmology CPT section
- CPT 92273 should be used to report global response of photoreceptors of the retina
- CPT 92274 should be used to report photoreceptors in multiple separate locations in the retina and macula
- Revisions and Additions to FNA and skin biopsy codes
- CPT codes 11102-11107 should be used to report skin biopsies based on method of removal including tangential (shave, scoop, saucerize, curette), punch and incisional.
- Fine needle aspiration (FNA) codes received new instructional updates including the clinical distinction between a fine needle aspiration and a core needle biopsy. Imaging guidance is now inclusive to the nine new codes. Guidelines also instruct that codes are selected based in guidance (included) and add on-codes are appended for each additional lesion.
- CPT codes 10005-10012 were added to report the specific imaging guidance (ultrasound, fluoroscopic guidance, CT and MRI).
- Revisions and Additions to psychological and neuropsychological testing
- 8 CPT codes 97151-97158 and guidelines were added to Adaptive Behavioral services to address deficient adaptive behaviors.
- New guidelines and new CPT codes were added to the Central Nervous System Assessments/Tests including 96112 and 91113 for developmental test administration based on time. CPT add on code 96121 for a neuro behavioral status examination for ab additional hour was added. Under Testing Evaluation Services CPT codes 96130-96133 were added for neuropsychological testing evaluation services based on time.
- CPT codes 96136-96139 were added to report psychological or neuropsychological report testing and scoring. Codes are based on time and whether the service was performed by a technician or clinician. CPT code 96146 is used to report psychological or neuropsychological automated testing using an electronic platform.
- 4 new breast MRI procedures were added
- CPT Codes 77046-77049
- Codes are selected based on laterality (unilateral vs. bilateral) and with or without contrast material.
- 2 new gastrostomy tube placement codes added to define simple versus complex replacement of a percutaneous gastrostomy tube.
- CPT 43762 is reported for the percutaneous gastrostomy tube placement including removal without imaging or endoscopic guidance not requiring revision of the gastrostomy tract
- CPT 43763 requires revision of gastrostomy tract
- 3 new codes for allografts
- CPT Codes 20932-20934
- CPT 20932 includes templating, cutting, placement and internal fixation; osteoarticular
- CPT 20933 includes hemicortical, intercalary, partial
- CPT 20934 includes hemicortical, complete.