Part 5: New 2020 CPT Codes | Modifiers, Category III, Evaluation and Management, etc.
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
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This is Part 5 of a five part series on the new 2020 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.
Two modifiers were revised:
Modifier 50 revised:
Do not append on add-on codes
Documentation throughout CPT has been standardized to state to report the add on code TWICE if done bilaterally.
Modifier 63 revised:
Added Medicine codes that are invasive cardiovascular procedures to the list for which this modifier can be assigned. See CPT code book for the list of these procedures.
Category III Codes
Category III CPT codes are released semi-annually, in January and July. There are 51 new, 11 deleted and 1 revised Category III codes. Review pages 776-808 of CPT book which indicate the new codes delineated by a red circle. Many of the Category III codes not already discussed in the previous 4 parts of this series involve more diagnostic and testing procedures across all specialties. Of note is a new series of codes for Islet cell transplantation, 0584T-0586T. Use Category III codes first before regular surgical CPT codes.
For radiology there are 12 new codes, 15 deleted, and 18 revised. There are many revised codes. There is an add on code for small intestine follow through study. Also there are new myocardial imaging codes. Please review this section if you assign these codes. Most of these codes however and entered into the chargemaster.
For this section there are 47 new codes, 21 deleted, and 10 revised Medicine CPT Codes.
There are new influenza and meningococcal vaccine codes along with new/revised biofeedback, ophthalmology, and EEG codes. In addition, there are new “Digital Evaluation and Management” codes that all professional fee coders should review.
Laboratory and Pathology
There are 89 new codes, 5 deleted and 5 revised codes. Most of the new codes and revisions involve molecular pathology, which is a growing field. Since many of these codes are inputted 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
There are new codes for online digital evaluation that are PATIENT INITIATED.
- 99421 Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
- 99422 … 11-20 minutes
- 99423 … 21 or more minutes
These codes are intended for PATIENT-INITIATED digital communications (such as those through patient portals) that require a clinical decision that would otherwise have been typically provided in the office. (NO CLINICAL STAFF TIME CAN BE COUNTED!)
If within 7 days of the initiation of online E/M services, a separately reported E/M visit occurs, then the MD/QHP work devoted to the online digital E/M service is incorporated into the separately reported E/M visit. (It is additive of time for a time based E/M visit or additive of MDM for other.)
This code has been deleted: 99444 Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network
There are new codes for self-measured blood pressure:
- 99473 Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration
This is for the patient initially receiving the device with training.
Only reported ONCE per DEVICE.
- 99474 Self-measured blood pressure using a device validated for clinical accuracy; separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient
The self-measured blood pressure readings helps to avoid “white coat hypertension.”
The code is for MD reviewing individual readings and telling clinical staff what to tell patient.
There is one updated and one new remote monitoring code:
▲99457 Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes
+●99458 … each additional 20 minutes (List separately in addition to code for primary procedure)
Must be a medical device as defined by FDA and must be ordered by an MD or QHP.
These codes are for use of device monitoring that do not currently have a separate CPT code for use.
Example, pt with heart failure with remote physiological monitoring.
E/M for FY2020: 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. CMS will allow physicians, physician assistants, and advanced practice registered nurses (APRN) to review and verify—through a simple “verify sign and date” process—rather than re-document notes made in the medical record by other physicians, residents, medical, physician assistants and APRN students, nurses, or other members of the medical team.
CMS also defined the APRN group of providers, which includes nurse practitioners, clinical nurse specialists, certified nurse-midwives, and certified registered nurse anesthetists.
Additionally, we are clarifying that for new and established patients chief complaint and history, (and exam, checking) practitioners need not re-enter in the medical record information that has already been entered by ancillary staff or the beneficiary or medical students or residents. The practitioner may simply indicate in the medical record that he or she reviewed and verified this information and then sign and date.
Beginning in CY 2021: CMS will implement payment, coding, and additional documentation changes for E/M office/outpatient visits, specifically:
- Allow physicians to choose their level based on whether their documentation is based on Medical Decision Making (MDM) or Total Time essentially eliminating history and physical exam as elements for code selection (but they still need to be documented as medically appropriate):
- MDM: The Workgroup did not materially change the three current MDM sub-components, but did provide extensive edits to the elements for code selection and revised/created numerous clarifying definitions in the E/M guidelines. (See next slide for additional discussion.)
- Time: The definition of time is minimum time, not typical time, and represents total physician/qualified health care professional (QHP) time on the date of service. The use of date-of-service time builds on the movement over the last several years by Medicare to better recognize the work involved in non-face-to-face services like care coordination. These definitions only apply when code selection is primarily based on time and not MDM.
- Modifications to the criteria for MDM: The Panel used the current CMS Table of Risk as a foundation for designing the revised required elements for MDM. Current CMS Contractor audit tools were also consulted to minimize disruption in MDM level criteria.
- Removed ambiguous terms (e.g. “mild”) and defined previously ambiguous concepts (e.g. “acute or chronic illness with systemic symptoms”).
- Also defined important terms, such as “Independent historian.”
- Re-defined the data element to move away from simply adding up tasks to focusing on tasks that affect the management of the patient (e.g. independent interpretation of a test performed by another provider and/or discussion of test interpretation with an external physician/QHP).
- Deletion of CPT code 99201: The Panel agreed to eliminate 99201 as 99201 and 99202 are both straightforward MDM and only differentiated by history and exam elements. So there will be 4 New Patient levels and 5 Established Patient levels.
- Previously proposed collapsing the five tier payment into two blended rates however with provider push back, CMS backtracked those changes.
- Creation of a shorter prolonged services code: The Panel created a shorter prolonged services code that would capture physician/QHP time in 15-minute increments. This code would only be reported with 99205 and 99215 and be used when time was the primary basis for code selection.
- Conversion factor for physician services: November 15, 2019
- December 31, 2019 – $36.04
- January 1, 2020 – $36.09
- January 1, 2020 – about a 0.14 percent increase
- Anesthesia conversion factor decreases from $22.27 to $22.20.
- Principal Care Management: Only one practitioner can bill; need to get consent to bill by law, table in the rule. Two services:
- G2064 – care management services furnished by the billing practitioner – $92
- G2065 – care management services furnished by the CLINICAL STAFF under the billing practitioner’s supervision – $40
- G2061 (qualified nonphysician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the seven days; 5-10 minutes).
- CMS is finalizing the addition of three new telehealth codes for opioid treatment as part of its new bundled care program for treatment of opioid use disorders:
- G2086, office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month
- G2087, …; at least 60 minutes in a subsequent calendar month
- Add-on code G2088, …; each additional 30 minutes beyond the first 120 minutes.
- Chronic Care Mgmt. G0258 (Add-on to 99490) each additional 20 min clinical staff time after initial 20 min, $38; maximum 2 billings
- Professional Fee coders should review the total list of G codes.
- CMS will pay for office based Opioid treatment Program benefit if requirements met. G2086 70 min first month; G2087 60 minutes G2088 each additional 30 minutes.
This concludes our five part series on new CPT codes for FY 2020!
The information contained in this coding advice 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 1 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include examples to help the coder understand the new codes. For 2021 in general, there were 199 new CPT codes added, 54 deleted and 69 revised.
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.
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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.
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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).
In the first parts of this series we looked at definitions of AKI/ARF, causes, coding and sequencing. In Part 3, we will look at what clinical indicators would possibly be present to support the diagnosis of AKI/ARF.
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.
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Effective with 4/1/2020 discharges, ICD-10-CM code U07.0 is used to report vaping -related disorders. ICD-10-CM code U07.0 (vaping related disorder) should be used when documentation supports that the patient has a lung-related disorder from vaping. This code is found in the new ICD-10-CM Chapter 22. U07.0 will be in listed in the ICD-10-CM manual under a new section: Provisional assignment of new disease of uncertain etiology or emergency use.
The US government and public-health officials are urging consumers to utilize telemedicine for remote treatment, fill prescriptions and get medical attention during the new coronavirus pandemic. The goal is to keep people with symptoms at home and to practice social distancing if their condition doesn’t warrant more intensive hospital care.
Coronavirus: Tips for working from home. Companies around the world have told their employees to stay home and work remotely. Whether you’re a new to this concept or a work from home veteran, here’s some tips to staying productive from our #HIAfamily.
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