Part 5: New 2020 CPT Codes | Modifiers, 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 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.
The Centers for Disease Control and Prevention (CDC) is in process of developing a new code for the COVID-19 (coronavirus) that will be released October 1, 2020. In the meantime, the CDC has provided advice on coding the COVID-19 coronavirus.
We’re finally at the #1 most common DRG with recommendations by HIA for 2019. Just to recap, HIA reviewed over 50,000 inpatient records in 2019. Most have probably already guessed what the correct DRG would be with the most recommendations. There are just some diagnoses and DRG’s that will always be a thorn in the side for coders. #1 DRG with the most recommendations during HIA reviews : DRG 871—Septicemia or severe sepsis w/o mechanical ventilation >96 hours with MCC
We’re now at the second most common DRG with recommendations by HIA for 2019. Just to recap, HIA reviewed over 50,000 inpatient records in 2019. We are counting down to # 1. #2 DRG with the most recommendations during HIA reviews: DRG 872—Septicemia or severe sepsis w/o mechanical ventilation >96 hours w/o MCC.
In 2019, HIA reviewed over 50,000 inpatient records. Wow! That is a lot of records. Even with this large number of records, the DRG’s with recommendations are still the ones that coders typically see during audits. #3 DRG 190—Chronic obstructive pulmonary disease with MCC.
In 2019, HIA reviewed over 50,000 inpatient records. Wow! That is a lot of records. Even with this large number of records, the DRG’s with recommendations are still the ones that coders typically see during audits. #4 is DRG 193—Simple pneumonia & pleurisy with MCC.
In 2019, HIA reviewed over 50,000 inpatient records. Wow! That is a lot of records. Even with this large number of records, the DRG’s with recommendations are still the ones that coders typically see during audits. #5 DRG with the most recommendations during HIA reviews : DRG 853—Infectious & Parasitic diseases with O.R. procedure with MCC
Pivotal moments in the Health Information Management field include the implementation of ICD-10, CPT Coding Changes, Acute care changes, profee changes, recovery audit contractor implementation, new ransomware challenges, Meaningful use and much more.
In 2019, we reviewed over 50,000 diagnosis codes from many different specialties for our Professional Fee clients. For the final part of this 3-part series, we will look at R00-R99 – Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified.
The Circulatory chapter is one that is identified every year as having a large number of coding changes. Many of these changes are related to documentation providing more specificity and, in some cases, less specificity than the codes reported. Below we will discuss some of the areas of opportunity in this chapter.
In 2019, we reviewed over 50,000 diagnosis codes from many different specialties for our Professional Fee clients. Here are the top three ICD-10-CM chapters where HIA identified coding opportunities: Z00-Z99 – Factors influencing health status and contact with health services; I00-I99 – Circulatory system and; R00-R99 – Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified.
This is Part 4 of a five part series on the new 2020 CPT codes. In this series we will explore the CPT changes for FY 2020 and include examples to help the coder understand the new codes. There is 3 new digestive system codes with 1 deletion and 2 revised; 1 revised urinary system codes with new category III codes; 6 new with 20 deleted nervous system codes with 3 revisions; 2 new eye codes with 3 revisions; and finally a new category III auditory code.
This is Part 3 of a five part series on the new 2020 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 11 new cardiovascular CPT codes added with 8 deletions and 2 revisions.
This is Part 2 of a five part series on the new 2020 CPT codes. In this series we will explore the CPT changes for FY2020 and include some examples to help the coder understand the new codes. There are 11 new musculoskeletal CPT codes added with 1 deletion and 0 revisions.
This is Part 1 of a five part series on the new 2020 CPT codes. In this series we will explore the CPT changes for FY2020 and include examples to help the coder understand the new codes. For 2020 in general, there were 248 new CPT codes added, 71 deleted and 75 revised.
This is Part 6 of a 6-part series focusing on CPT coding of breast procedures. There are many different types of breast reconstruction procedures, each having potential stumbling-blocks for coders. Part 6 focuses on revision of a reconstructed breast.
This is Part 5 of a 6-part series focusing on CPT coding of breast procedures. There are many different types of breast procedures, each having potential stumbling-blocks for coders. This series will address several of the more confusing topics. Part 5 focuses on the coding of different types of autologous tissue breast reconstruction procedures.
Part 4: CPT Breast Education Series | Use of Acellular Dermal Matrix with Breast Implant Reconstruction
This is Part 4 of a 6-part series focusing on CPT coding of reconstructive procedures following mastectomy. There are many different types of breast reconstruction procedures, each having potential stumbling-blocks for coders. Part 4 focuses on the use of acellular dermal matrix with breast implant reconstruction.
Part 3: CPT Breast Education Series | Immediate Versus Delayed Permanent Breast Implant Reconstruction
This is Part 3 of a 6-part series focusing on CPT coding of breast procedures. There are many different types of breast procedures, each having potential stumbling-blocks for coders. This series will address several of the more confusing topics. Part 3 focuses on the difference between immediate and delayed permanent breast implant reconstruction.
This is Part 2 of a 6-part series focusing on CPT coding of breast procedures. There are many different types of breast reconstruction procedures, each having potential stumbling-blocks for coders. This series will address several of the more confusing topics. Part 2 focuses on the use of tissue expanders in breast reconstruction.
With the implementation of ICD-10-PCS the description of codes became much more detailed to describe exactly what is being performed. Cardiac catheterization is one of the descriptions that changed to further detail exactly what is being performed during the procedure.
This is Part 1 of a 6-part series focusing on CPT coding of reconstructive procedures following mastectomy. There are many different types of breast reconstruction procedures, each having potential stumbling-blocks for coders. Part 1 is an overview of the types of breast reconstruction techniques commonly used. Future topics in this series will go into more detail of each technique and the CPT coding implications.
With Christmas fast-approaching, we’re making a list of our favorite holiday movies and checking it twice. And in the spirit of good humor and cheer, we’ve added some ICD-10 codes to these holiday classics. Have a safe, happy, and healthy holiday everyone!
“Lobar” pneumonia references a form of pneumonia that affects a specific lobe or lobes of the lung. This is a bacterial pneumonia and is most commonly community acquired. Antibiotics are almost always necessary to clear this type of pneumonia.
In Parts 1, 2 and 3 we learned about what sepsis is, sequencing of sepsis and what documentation is needed to report severe sepsis. In Part 4, we will look at clinical indicators needed to clinically support the diagnosis of sepsis and determine if a query is indicated.
Severe sepsis occurs when sepsis progresses and signs of organ dysfunction/failure develop. One site stated that approximately 30% of patients with severe sepsis do not survive. Patients may develop one organ dysfunction/failure, multi-system organ failure and/or septic shock.
In Part 2 of our Sepsis Series, we are going to focus on sequencing of sepsis when the diagnosis is clearly documented. Later in the series we will look at what to do when the diagnosis is not clearly documented.
In this series, we will learn what sepsis is or causes of sepsis, how to sequence the diagnosis in ICD-10-CM, what are the clinical indicators for sepsis, is a query necessary before reporting the diagnosis of sepsis, and how to prevent denials on sepsis records.
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 FY2020 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2020.
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 FY2020. On August 2, 2019, CMS published the Final Rule for IPPS (CMS-1716) FY2020 IPPS Final Rule.