CPT Coding: A Look at What’s Coming in 2019

by | Nov 19, 2018 | Coding Tips, CPT, Education, Patricia Maccariella-Hafey | 0 comments

Patricia Maccariella-Hafey, RHIA, CDIP, CCS, CCS-P, CIRCC has over 35 years expertise in the areas of ICD-9-CM, CPT, DRG/APC validation Professional Fee E&M coding, Interventional Radiology, and Facility E&M coding. Patricia is currently Director of Education a healthcare consulting firm specializing in coding compliance review, education and contract coding services.

Pat Maccariella‑Hafey
RHIA, CDIP, CCS, CCS‑P, CIRCC

Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador

It’s that time of the year where HIM professionals take a peek at what changes are coming for CPT in the new year, 2019.  Did you know that CPT started in 1966 with about 3,500 codes?

For 2019, there are a total of 10,294 CPT codes! Here is a breakdown of the numbers:

  • 212 Added
  • 73 Deleted
  • 50 Revised

Surgery

Most of the changes in the surgery section concern the 15 new CPT codes within the Integumentary subsection. Six new skin biopsy codes have been added (11102-11107) to differentiate between tangential, punch and incisional skin biopsies. Tangential biopsies involve a shave, scoop, saucerize or curette type of biopsy. Coders must not confuse this with the existing “shaving of lesion” codes, 11300-11313 as a tangential biopsy is just that, a biopsy and not a removal of lesion. In addition, when there is a combination of different types of skin biopsies done, such as a tangential and a punch biopsy, the highest code in the hierarchy is reported for the primary code (punch,) and add on code for second biopsy (tangential). There are extensive notes and a table within the CPT book that coders must reference and become familiar with in order to accurately assign these codes.

In addition there are 1 revised and 9 new codes for fine needle aspiration (FNA) biopsy of skin (10021, 10004-10012.) These codes differentiate each FNA biopsy by the type of imaging guidance used, (none, US, Fluoro, CT, MR) with add on codes for each additional lesion biopsied.  Once again, CPT has extensive notes and directions on how to report multiple FNA biopsies using different types of imaging, depending on if the biopsies are on the same or different lesion. Coders must review the explanation and notes provided to accurately report these procedures as it can get confusing.

There are three new codes for osteoarticular, hemicortical intercalary, partial and intercalary complete allografts. (20932-20934) There is one new code 27369 for injection procedure for contrast knee arthrography or contrast enhanced CT/MRI knee arthrography to help alleviate confusion of these injections. Code 27370 was deleted.

For cardiology, the old category III codes of 0387T and 0388T for transcatheter insertion/replacement or removal of permanent leadless pacemaker, right ventricular have new category I codes, 33274, 33275. There is also a new code for replacement of aortic valve by translocation of autologous pulmonary valve, 33440. PICC line insertion codes have been revised to include or not include all imaging guidance. See 36568-36584. Also note that Appendix L in the back of the CPT book has new color coded ordered artery and vein anatomy photos to ease in selecting interventional radiology codes. This is a new addition this year.

There are several new codes scattered among the remaining body systems and category III codes.

We will offer an overview of these in our  “New CPT Codes and HOPPS Changes CY2019” education session, coming soon to our Action Plan Library.

Evaluation and Management

For evaluation and management, there are 4 revised (99446-99449) and 2 new codes (99451-99452) for interprofessional internet consultation codes. There are also several new (99453-54) and revised codes and new subsection for digitally stored data services/remote physiologic monitoring. With  so many patients accessing record information and interacting with their provider over internet records, CPT continues to expand codes to capture the interactions. There is one new code 99491 for case management services.  Coders must read the extensive notes at these new subsections to accurately report these codes.

One caveat of the final rule, CMS is NOT going to condense the reimbursement to one payment rate for E/M levels 2-4 until the year 2021.

Documentation requirements have eased up a bit. For established patients history and exam, when relevant information is already contained in the medical record, practitioners may choose to focus their documentation on what has changed since the last visit, or on pertinent items that have not changed, and need not re-record the defined list of required elements if there is evidence that a practitioner reviewed the previous information and updated it as needed. Also, for a new and established patients, chief complaint and history need not be re-entered in the medical record if it has already been entered by ancillary staff or the beneficiary. The practitioner may simply indicate in the medical record that he or she reviewed and verified this information. CMS also eliminated the requirement to document the medical necessity of  a home visit in lieu of an office visit. For more changes, see the 2019 CPT book.

References
CPT code book 2019 American Medical Association
cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/
amazonaws.com/public-inspection.federalregister.gov/2018-24170.pdf

The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.

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