Part 5 – New 2019 CPT Codes: Category III, Evaluation and Management, etc.
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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.
Last week, we looked at tidbits for reporting the ICD-10-CM codes for pregnancy/obstetric records. Now we will look at some for the ICD-10-PCS reporting of these records. In reporting the appropriate ICD-10-PCS codes a coder must know what is included in the terminology of products of conception (POC).
Chances are, we all know someone affected by heart disease and stroke, because about 2,300 Americans die of cardiovascular disease each day, an average of 1 death every 38 seconds. But together we can change that.
There was a time when coding delivery records was considered simple. Many times, these types of records were given to the newer coders. However, as coding becomes more complex, this is no longer the case. With the implementation of ICD-10-CM came more codes for very detailed and specific issues that occur during pregnancy, childbirth and the puerperium.
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Allison Curry, RHIT, CCS, Coding Specialist at Health Information Associates, about the steps she takes to find her routine.
One way to shorten a lengthy query is by avoiding repetition in the supporting documentation. Does the same diagnosis really need to be mentioned multiple times in the clinical indicators? Is it necessary to list the results of a chest x-ray twice? Does listing the same documentation multiple times give further specification or explanation to the query?
Tobacco use can lead to tobacco/nicotine dependence and serious health problems. Quitting smoking greatly reduces the risk of developing smoking-related diseases. Tobacco/nicotine dependence is a condition that often requires repeated treatments, but there are helpful treatments and resources for quitting.
This is Part 4 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. There is 1 new lymphatic code, 2 new digestive system codes with 3 deletions, 3 new urinary system codes with one deletion and 7 deleted nervous system codes with 2 revisions.
This is Part 3 of a five part series on the new 2019 CPT codes. In this series we will explore the CPT changes for FY2019 and include examples to help the coder understand the new codes. There are 9 new cardiovascular CPT codes added with 2 deletions and 3 revisions.
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Tilina Sablan, RHIT, CCS, Coding Specialist with Health Information Associates, about the steps she takes to find her routine.
This is Part 2 of a five part series on the new 2019 CPT codes. In this series we will explore the CPT changes for FY2019 and include examples to help the coder understand the new codes. There are 4 new musculoskeletal CPT codes added with 2 deletions and 0 revisions.
This is Part 1 of a five part series on the new 2019 CPT codes. In this series we will explore the CPT changes for FY2019 and include examples to help the coder understand the new codes. There were 15 new integumentary CPT codes added with 3 deletions and 1 revision.
In part 5 of our series, we look at DRG 64—Intracranial hemorrhage or cerebral infarction with MCC. For this DRG recommendation the majority (almost all) were recommended to DRG 65 (Intracranial hemorrhage or cerebral infarction with CC) with deletion of the reported MCC.
The majority of the recommendations from DRG 190 (Chronic obstructive pulmonary disease w/MCC) was to DRG 189 (Pulmonary edema and respiratory failure) with re-sequencing of respiratory failure as the PDX or adding as a new code and sequenced as PDX.
The majority of the recommendations from DRG 853 (Infectious & parasitic disease with O.R. procedure with MCC) were to DRG 871 (Septicemia w/o MV 96+ hours with MCC) with deletion or revision of the PCS code. Some of these required physician query.
The majority of the recommendations from DRG 872 (Septicemia w/o mechanical ventilation 96+ hours w/o MCC) were to DRG 871 (Septicemia w/o mechanical ventilation 96+ hours with MCC) with the addition of an MCC to the account. Not all of these required a physician query and were present in the medical record documentation without any clarification needed prior to coding.
The majority of the recommendations from DRG 871 (Septicemia w/o MV 96+ hours with MCC) were to DRG 872 (Septicemia w/o MV 96+ hours w/o MCC) with the recommendation to delete the reported MCC or query for clarification to support the MCC that had been reported.
Every year, we make plans to live a healthier, more organized, and balanced life. For some of us, we end up falling short of those expectations. This year, to keep us on track with our New Year’s goals, we have put together a few of the most common New Year’s resolutions along with their ICD-10 diagnoses codes. Check out our tips and tricks for a healthy 2019!
Top 5 ProFee diagnosis changes found in recent HIA reviews: 1. I10 – Essential (Primary) Hypertension; 2. E11.9 – Type 2 Diabetes Mellitus Without Complications; 3. K29.60 – Other Gastritis Without Bleeding; 4. R13.19 – Other Dysphagia; 5. I25.10 – Atherosclerotic Heart Disease of Native Coronary Artery Without Angina Pectoris.
What is the principal procedure? The procedure that is performed for definitive treatment or is taking care of a complication is the principal procedure. Procedures for diagnostic or exploratory purposes that are performed in addition to a procedure being performed for definitive treatment, would be reported in addition to the principal procedure.
A query question that is directive in nature, indicating what the provider should document, rather than asking for his/her professional determination of clinical facts, constitutes a leading query. The provider should not be made to feel obligated to document anything.
When I start coding a chart, I enter all account information in log and do any abstracting—disposition, admitting, and attending—take care of all of that first. ED, H&P, consult, progress reports, and discharge summary.
Some Speed Reading Tips: Once you start reading, don’t stop! Read the text straight through. If you have any question after you have completed reading the material, go back and reread the relevant sections. Reread the marked sections of the text (the items you indicated that you didn’t quite understand). Write a small summary at the beginning of the chapter – consisting about 3-4 sentences.
A burr hole is a small hole that is made in the skull with a drill by the surgeon. First, (after prepping the site) the scalp is cut (incised) at the desired location by the surgeon. The surgeon will then drill 1 or 2 small holes in the skull at this area to reach the dura.
The cause/etiology of GI bleeding is not always easily determined. During procedures, to work the bleeding up, there are often multiple potential sources of bleeding found but not identified as the culprit. Many of these findings have “with” or “in” in the main or subterms.
On December 1, 2018, the HIA team based at our headquarters in Pawleys Island, South Carolina received a visit from a surprise guest – meet Otis, HIA’s very own Elf on a Shelf. Otis will be sticking around until Christmas to keep an eye on all of us. We have a feeling he may get into some trouble! Check back daily to see what Otis is up to. #OtisOnOtisDrive
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our new series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Crystal Junkins, CCS, CPC, Coding Specialist with Health Information Associates, about the steps she takes to find her routine.
COPD is a respiratory condition where there is chronic obstruction to airflow in the lungs. Air is breathed into the lungs but a patient with COPD has trouble emptying air out of the lungs. This can also cause patients with COPD to have CO2 retention. COPD is an irreversible and progressive disease in which the lung function worsens as time goes on.
Tissue findings interpreted by a pathologist are not equivalent to the attending physician’s medical diagnosis based on the patient’s clinical condition. If the attending physician has not indicated the significance of an abnormal finding within a pathology report…
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.