Part 5 – New 2019 CPT Codes: Category III, Evaluation and Management, etc.
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador
This is Part 5 of a five part series on the new 2019 CPT codes. In this series we will explore the CPT changes for FY 2019 and include examples to help the coder understand the new codes. For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.
Category III Codes
Category III CPT codes are released semi-annually, in January and July. There are 38 new, 29 deleted and 3 revised Category III codes. Review pages 764-789 of CPT book which indicate the new codes delineated by a red circle. Many of the Category III codes not discussed in the previous 4 parts of this series involve more diagnostic and testing procedures across all specialties. Of note is a new “Cellular and Gene Therapy” subsection. This subsection includes codes 0533T-0536T Continuous recording of movement disorder symptoms and 0537T-0542T Chimeric antigen receptor T-cell (CAR-T) therapy.
Use Category III codes first before regular surgical CPT codes.
For radiology there are 10 new codes, 6 deleted, and 4 revised. There are 6 new ultrasound and ultrasound with elastography codes scattered throughout the chapter (76391, 76978-76979, 76981-76983). Transient elastography gives a quantitative one-dimensional (i.e. a line) image of tissue stiffness. It functions by vibrating the skin with a motor to create a passing distortion in the tissue (a shear wave), and imaging the motion of that distortion as it passes deeper into the body using a 1D ultrasound beam.
There are 4 new magnetic resonance imaging of breast codes, 77046-77049. These codes now denote if without contrast or without and with contrast materials including CAD to reflect current practice. Old codes 77058,77059 have been deleted.
For this section there are 29 new codes, 13 deleted, and 17 revised Medicine CPT Codes.
1 new code 93264, is for remote monitoring of wireless pulmonary artery pressure sensor.
There are 7 new or revised neurostimulator monitoring codes. There is a new “Adaptive Behaviour Services – Assessments – Treatment” subsections and other CNS testing.
Laboratory and Pathology
There are 95 new codes, 5 deleted and 15 revised codes. Most of the new codes and revisions involve molecular pathology, which is a growing field. Since many of these codes are inputting in the pathology or laboratory departments via chargemaster, the hospital will want to be sure the chargemaster is up to date and personnel in these departments are aware of the updates.
Evaluation and Management
For E&M there are 6 new codes, and 5 revised codes. The subsection for “Interprofessional Telephone/Internet/Electronic Health Record Consultations” updated with “Electronic Health Record” along with the notes.
“Electronic Health Record” was added to codes 99446-99449 for interprofessional telephone/internet/electronic health record assessment and management service.
The below two new codes were created to reflect the growing use of the online electronic health record to interact with patients.
- 99451 Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating /requesting physician or other qualified healthcare professional, 5 minutes or more of medical consultative time
- 99452 Interprofessional telephone/internet/electronic health record referral services provided by a treating /requesting physician or other qualified healthcare professional, 30 minutes
Report 16-30 min of a service day for time spent preparing for the referral and/or communicating with
the patient using code 99452. If over 30 minutes, use prolonged services codes.
There is a new subsection for “Digitally Stored Data Services/Remote Physiologic Monitoring.” Report remote monitoring services such as weight, blood pressure, pulse oximetry during a 30 day period. The device must be a medical device as defined by the FDA.
- 99453 Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial, set-up and patient education on use of equipment
(Do not report more than once per episode of care or for monitoring under 16 days
- 99454 Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.
(Do not report for monitoring under 16 days or if monitoring covered under another code)
▲ 99091 Collection and interpretation of physiologic data code was updated with adding “each 30 days” so this code can only be reported once per 30 days
There is another new subsection “Remote Physiologic Monitoring Treatment Management Services” with notes.
- 99457 Remote physiological monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communications with the patient/caregiver during the month
This code is used when QHCP use the results of remote physiological monitoring to manage a patient under a specific treatment plan. It is also used when it does not meet requirements to report a more specific service. (Report once per 30 days regardless of the number of parameters monitored.
(Do not report 99457 with 99091)
One new code was created under the Chronic Care Management Services.
99491 Chronic care management services, provided personally by a physician or other QHCP at least 30 minutes of physician/QHCP time, per calendar month, with the following required elements:
- Multiple (2 or more) chronic conditions expected to last at least 12 months or death
- Chronic conditions place patient at risk of death, acute exacerbation or decline
- Comprehensive care plan established, implemented, revised or monitored
More E&M information in general:
Good news is CMS is delaying implementation of E/M payment changes. CMS will collapse payment rates for E/M office visits levels 2 through 4 rather than levels 2 through 5 beginning in 2021. CMS will keep a separate payment rate for level 5 visits to account for time and care associated with complex patients.
CMS has also eliminated the requirement to document the medical necessity of a home visit in lieu of an office visit.
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 the practitioner reviewed the previous information and updated it as needed.
Additionally, CMS is clarifying that for new and established patients chief complaint and history, practitioners need not re-enter in the medical record information that 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.
Beginning in CY 2021, CMS will implement payment, coding, and additional documentation changes for E/M office/outpatient visits, specifically:
- Single rates for levels 2 through 4 for established and new patients, maintaining the payment rates for E/M office/outpatient visit level 5 in order to better account for the care and needs of complex patients;
- Add-on codes for level 2-4 visits that describe the additional resources inherent in visits for primary care and particular kinds of non-procedural specialized medical care;
- A new “extended visit” add-on code for level 2 through 4 visits to account for the additional resources required when practitioners need to spend additional time with patients.
- For level 2 through 5 visits, choice to document using the current framework, MDM or time;
- When time is used to document, practitioners will document the medical necessity of the visit and that the billing practitioner personally spent the required amount of time face-to-face with the beneficiary (typical CPT time for code reported, plus any extended/prolonged time).
This concludes our five part series on new CPT codes for FY 2019! Happy Coding!
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.
This is Part 5 of a five part series on the new 2021 CPT codes. For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.
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In January, new CPT codes were released. There were 248 new CPT codes added, 71 deleted and 75 revised. Most of the surgery section changes were in the musculoskeletal and cardiovascular subsections. These included procedures such as skin grafting, breast biopsies, deep drug delivery systems, tricuspid valve repairs, aortic grafts and repair of iliac artery.
We have seen many updates and changes to COVID-19 (SARS-CoV-2) since the pandemic started. On January 1, 2021 we will see even more changes as outlined in this post. Also the CMS MS-DRG grouper will be updated to version 38.1 to accommodate the changes.
In the previous three parts of this four-part series, we discussed the new ICD-10-CM diagnosis code changes, ICD-10-PCS procedure code changes and FY2021 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2021.
In the previous two parts of this four part series, we discussed the new ICD-10-CM diagnosis code changes and ICD-10-PC procedure code changes. In this session we will review the major IPPS changes for FY2021.
This is Part 2 of a 4 part series on the FY2021 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented. For FY2021 ICD-10-PCS there are 78,115 total codes (FY2020 total was 77,571); 556 new codes (734 new last year in FY2020)…
This is Part 1 of a 4 part series on the FY2021 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis changes. Here is the breakdown: 72,616 total ICD-10-CM codes for FY2021; 490 new codes (2020 had 273 new codes); 58 deleted codes (2020 had 21 deleted codes); 47 revised codes (2020 had 30 revised codes)
Acute pulmonary edema is the rapid accumulation of fluid within the tissue and space around the air sacs of the lung (lung interstitium). When this fluid collects in the air sacs in the lungs it is difficult to breathe. Acute pulmonary edema occurs suddenly and is life threatening.
“Client S” is a small, not-for-profit, 40 bed micro-hospital in the Southeast. HIA performed a 65-record review this year for Client S and found an opportunity with 15 of them. 9 had an increased reimbursement with a total of $43,228 found.
The coma scale codes (R40.2-) can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebrovascular disease codes. These codes are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale may also be used to assess the status of the central nervous system for other non-trauma conditions, such as monitoring patients in the intensive care unit regardless of medical condition.
In the past, there had been an Excludes1 note at I46.- Cardiac arrest that excluded R57.0, Cardiac shock. HIA had also received a letter from AHA on a case in the past that had stated that only I46.- Cardiac arrest would be coded if both were documented. In addition, the Third Quarter Coding Clinic page 26 had a similar case that asked if both could be coded, and AHA had instructed that only I46.9, cardiac arrest, cause unspecified would be coded if both were documented and that the CDC would be looking at possible revision to the Excludes1 note.
A higher CMI corresponds to increased consumption of resources and increased cost of patient care, resulting in increased reimbursement to the facility from government and private payers, like CMS. We know that documentation directly impacts coding.
Lately we have seen several cases where the endarterectomy was assigned along with the coronary artery bypass (CABG) procedure when being performed on the same vessel to facilitate the CABG. A coronary artery endarterectomy is not always performed during a CABG procedure, so when it is performed it becomes confusing as to whether to code it separately or not.
Assign code Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases” for all patients who are tested for COVID-19 and the results are negative, regardless of symptoms, no symptoms, exposure or not as we are in a pandemic.
The Centers for Medicare & Medicaid Services (CMS) announced new procedure codes for treatments of COVID-19 – effective as of August 1, 2020. Among the new codes are Section X New Technology codes for the introduction or infusion of therapeutics including Remdesivir, Sarilumab, Tocilizumab, transfusion of convalescent plasma, as well as introduction of any other or new therapeutic substances for the treatment of COVID-19.
One common element in many value-based programs is risk adjustment using Hierarchical Condition Categories (HCCs) to create a Risk Adjustment Factor (RAF) score. This method ranks diagnoses into categories that represent conditions with similar cost patterns.
Why are so many AKI records being denied? It’s hard to give one answer for why so many AKI records are being denied lately, but most appear to be due to the multiple sets of criteria available for use in determining if a patient has AKI, as well as physician documentation. As stated in Part 3 of this series, there are three main criteria/classifications used to diagnose AKI.
In previous parts of this series we looked at the definitions of AKI/ARF, causes, coding and sequencing, and the common clinical indicators that patients present with that are diagnosed with this condition. In Part 4, we will look at the documentation that should be present to report the diagnosis without fear of denial, as well as when a query is needed to clarify the diagnosis.
If the facility does a COVID-19 test, and test is negative, do I need a diagnosis code. The answer is yes, you will report a Z-code. The Z-code depends on the record documentation and circumstances of testing. For any patient receiving a COVID-19 test, if negative, there MUST e a Z-code to describe why the test was taken. (Test negative for COVID-19 and MD does not override negative results).
The FY2021 IPPS Proposed Rule is out and here are some highlights from it regarding ICD-10 Code proposals. We will know if these changes are permanent after the public comment period is over on July 10, 2020 and CMS prepares the Final Rule, usually out by August 1.
As discussed in Part 1 of this series, AKI/ARF is a common diagnosis that coders see daily. In Part 2, we are going to focus on the different types/specificity of AKI/ARF. We’ll learn what they mean, as well as how to code the diagnosis.
This is part 1 in a series focused on coding of acute kidney injury (AKI) and/or acute renal failure (ARF). AKI/ARF is reported often, but is also one of the most common diagnosis found in denials.
With the proliferation of COVID-19 cases, we thought we would put together a quick reference listing of some of the common scenarios that coders have asked about. As with all coding, coders should follow Official Guidelines for Coding and Reporting and the COVD-19 Frequently Asked Questions document by the AHA.
Effective March 1, Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19. This great for providers whose patients are reluctant to visit the office.
The biggest reasons why some hospital systems are moving to single path coding is to eliminate duplicative processes and to optimize productivity. In addition, costs are reduced when only one coder “touches” the record and completes both types of coding.