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CPT 2019 Updates

EVALUATION & MANGEMENT


Critical Care services
• Time spent in activities, outside of the unit or off the floor or not
directly contributing treatment, even done under critical care
unit, its not considered as critical care

• Separate procedure servicer time – not to be included in CC time.


Interprofessional Health Record Consultations
• Attending physician requests opinion/ treatment advice with
specific specialty expertise to assist him in the diagnosis/
management without patient face to face contact with
consultant.

• Consultant should not face the patient within 14 days.

• If situation converts for face to face, these codes nit applicable.


Interprofessional Health Record Consultations
• 99446 – 99449, 99451 for greater than 50% for consulting medical related reviews
and not be reported for greater than 50% for consulting Data reviews.

• More than one consultation request should be reported with single code, not more
than once within seven day interval.

• These interpersonal consultation should not be reported less than 5 minutes.

• Prolonged service codes has been coded along with these, if the time exceeds 30
minutes.

• 99457 is a new code that requires live, interactive communication with the
patient/caregiver and 20 minutes or more of clinical staff/physician or other qualified
health care professional time in a calendar month.
Remote Physiologic Monitoring
• 99453, 99454 – 30 day period – weight, BP, Pulse Oximetry.

• These codes not applicable for less than 16 days monitoring.

• These codes are included in other codes of monitoring services.

• 99091 – cannot be reported for,


• when done with same encounter for EM,
• Same calendar month of care plan sight , domiciliary and rest home services.
• Transfer & interpretation of data from hospital
Care Management Services
• 99487, 99489, 99490, 99491 - reported once per calendar month
and may only be reported by single physician.

• 99491 - Only the time of the clinical staff of the reporting


professional is counted and also don’t count for the day of
initiating visit.

• 99491 - Chronic Care Mgmt Svc At Least 30 Min Per Month


Integumentary System
FNA
• Fine needle aspiration (FNA) - material aspired with fine needle and cells
examined cytologically.

• Core needle biopsy - material aspired with large bore needle and tissues
examined with histo pathological evaluation.

• Imaging guidance was added to the nine new codes and reporting imaging
guidance separately is no longer reportable. Guidelines also direct that the codes
are selected based in guidance (included) and add on-codes for each additional
lesion, same imaging modality.

• 10021 (FNA) without imaging guidance is reported and 10022 was replaced with
CPT 10004 for each additional lesion.

• Codes 10005-10012 were added to report the specific imaging guidance


(ultrasound, fluoroscopic guidance, CT and MRI).
FNA
• More than one FNA – same lesion – same day – same session – same imaging
modality – Code appropriate imaging add on code for second & subsequent
lesion.

• More than one FNA – separate lesion – same day – same session – different
imaging modality – Append 59 modifier along with additional imaging modality
and add on codes for second & subsequent lesion sampled.

• If FNA & Core biopsy - same lesion – same day – same session – same imaging
guidance – Do not append the separate code for imaging guidance of core
biopsy.

• If FNA & Core biopsy - separate lesion – same day – same session – same
imaging guidance/different guidance – Code both the core needle biopsy and
imaging guidance for the core needle biopsy with 59 modifier
Biopsy
• Tangential Biopsy – (Shave/Scoop/Saucerize, curette) - superficial biopsy not full
thickness of dermis layer

• Punch Biopsy – punch tool to remove a full thickness cylindrical sample of skin.

• Incisional Biopsy – Full thickness deep in to dermis/subcutaneous space.

• If multiple Biopsies done with same Technique – Code one base code and other
lesions with add on codes.

• If multiple Biopsies done with different Technique – Code one base code of one
technique and others with add on codes.
Biopsy
• 3 Tangential Biopsy – 11102, 11103 x 2

• 1 Tangential Biopsy + 1 Punch Biopsy + 1 Incisional Biopsy– 11106, 11103,


11105
Moh’s Surgery

• If repair is done - use separate repair, flap/graft codes.

• Biopsy – suspected skin cancer performed on same day as Moh’s surgery –


also no prior pathological confirmation on dx - Code diagnostic cskin biopsy
with frozen pathology (88331) with 59 modifier.
Musculoskeletal System
2 Series
• I & D for subfascial soft tissue abscess – code I & D for specific anatomic sites.

• 20932-20934 were added for allografts.

• 20932 includes templating, cutting, placement and internal fixation; osteoarticular,

• 20933 is hemicortical, intercalary, partial and 20934 is hemicortical, complete.

• 27369 was added to report an injection procedure for contrast knee arthrography
or contrast enhanced CT/MRI knee arthrography. (27370 – deleted)

• Same other than contrast for subsequent arthropathy, see 20610, 20611
Cardiovascular System
Pacemaker
• 33274 and 33274 - Reporting a transcatheter insertion or replacement and
removal of a permanent leadless pacemaker, right ventricle. code 33275 for
only removal

• Right heart catheterization codes may be reported with these leadless


pacemaker codes, when RHC is done for an indication distinct from leadless
pacemaker procedure.

• 33234, 33235/33244 - Removal of transvenous electrode attempted by


transveous extraction.

• 33238, 33243 - Removal of transvenous electrode by thoracotomy.


Pacemaker
• 33212,33213,33221,33230,33231,33240 – add in addition to
thoracotomy/epicardial lead pacemaker codes 33202/33203 – if insertion of
generator done with same physician during same encounter.

• Device Management codes from medicine section may not be reported


with these 3 series codes.

• Radiological S&I codes included in these codes, but fluoroscopic guidance


for diagnostic lead evaluation without lead insertion, replacement or
revision - 76000
Cardiac Rhythm Monitor
• 33285 and 33286 - Insertion and removal of a subcutaneous cardiac rhythm
monitor

• 33289 - Transcatheter implantation of a wireless pulmonary artery pressure


sensor.

• 93264 - Remote monitoring of a wireless pulmonary artery pressure sensor


for up to 30 days.

• 33440 was added for the replacement of the aortic valve by translocation
called Ross-Konno procedure.
Cardiac Rhythm Monitor
• 33866 created for an aortic hemiarch graft.

• Use these code, when performed in conjunction with ascending aortic graft
codes 33860, 33863, 33864.

• It includes
• Total circulatory arrest/ isolated cerebral perfusion.
• Incision in to transverse arch extending under one or more of arch vessels.
• Extension of ascending aortic graft by construction of beveled anastomosis to distal
ascending aorta n arch without cross clamp.

• 38531 - Biopsy or excision of an open inguino femoral lymph node.


CVC
• 36568 & 36569 - Insertion of a peripherally inserted central venous catheter
(PICC) without a subcutaneous port or pump without imaging guidance, less
than/ greater than equals 5 years

• 36572 and 36573 - Insertion of a peripherally inserted central venous


catheter (PICC) without a subcutaneous port or pump with imaging guidance,
less than/ greater than equals 5 years.

• Midline catheters placement reported with 36400,36405, 36406,36410

• 36572, 36573, 36584 should be appended with modifier 52, when performed
PICC insertion without confirmation for catheter tip location.
Digestive System
Gastrostomy Tube
• 43760 was deleted

• 43762 - Percutaneous gastrostomy tube placement including removal


without imaging or endoscopic guidance not requiring revision of the
gastrostomy tract

• 43763 - Revision of gastrostomy tract.

• These codes were added to define simple versus complex replacement of a


percutaneous gastrostomy tube.
HCPCS - Gastroenterology
Genitourinary System
5 series
• 50436 and 50437 - Dilation of existing tract, percutaneous for an endourologic
procedure including imaging guidance with post procedural tube placement.

• 50436 – Not be reported with 50432, 50433, 52334 (basic dilation with initial
placement of catheter).

• These code includes pre-dilation UT, post nephrostomy tube placement, imaging,
S&I.

• 50437 – Includes all of 50436 and also new access into the renal collecting system
is performed.

• 53854 - Transurethral destruction of prostate tissue by radiofrequency generated


water vapor thermotherapy.
6 series
• Code 64508 – Injection, anesthetic agent; carotid sinus (separate procedure) – has
been deleted.

• Imaging guidance included in most of the pain injection procedures.


• Interlaminar epidurals (codes 62321, 62323, 62325, 62327),
• paravertebral blocks (codes 64461 – 64463),
• transforaminal epidurals (codes 64479-64484),
• TAP (transverse abdominis plane) blocks (codes 64486-64489),
• paravertebral facet joint injections (codes 64490-64495) and
• facet joint ablation (codes 64633-64636).

• Imaging is also included in some of the codes that pertain to pumps and
neurostimulators.
Radiology
Radiology
• New codes were established for ultrasound elastography,

• 76981-76983 – These codes is per organ, first target lesion and each additional
target lesion.

• Magnetic resonance elastography is new diagnostic imaging technology.

• 76391 - Magnetic resonance (vibration) elastography.


Radiology
• 76978-76979 - Ultrasound procedures that use dynamic microbubble-sonographic
contrast with targeted ultrasound to evaluation lesions.

• When evaluating a parenchymal organ and lesion(s) in the same parenchymal


organ at the same session, only 76981 is to be reported and it is to be
reported only once per session for evaluation of the same parenchymal
organ.

• Shear wave liver elastography without imaging is to be reported using CPT


91200.

• These new codes eliminate HCPCS code 0346T that was previously used for
ultrasound elastography in addition to another primary procedure.
Radiology
Radiology
Radiology
• 77048 and 77049 also include computer-aided detection (CAD real-
time lesion detection, characterization and pharmacokinetic analysis)
when performed.

• This bundling eliminates the separate use of HCPCS code 0159T that
was previously added when performing CAD.

• 76391 has been issued for MR Elastography.


Radiology
Nuclear Medicine
• Three nuclear medicine codes (78270, 78271, and 78272) related to Vitamin B-12
absorption studies have been eliminated.

Other Diagnostic Radiology


• CPT 76001 for more than one hour of fluoroscopy time has been eliminated, leaving
CPT 76000 as the only choice for fluoroscopy time reporting.
Medicine
Medicine
• 90689 - Inactivated adjuvanted preservative free flu vaccination.

• In the Ophthalmology section,


• 92273 and 92274 were added.

• These are eletroretinography procedures to evaluate function of the retina and optic
nerve of the eye.

• 92273 - Global response of photoreceptors of the retina

• 92274 - Photoreceptors in multiple separate locations in the retina and macula.


Medicine
• In the Electrocorticography section,

• 95836 (electrocorticogram) - Recording of ECG from electrodes chronically implanted on or in the brain to
allow for intracranial recordings to continue after the patient has been discharged from the hospital.

• 95971, 95972, 95976, – Electronic analysis with simple (adjustment of 1 to 3 parameters) programming of
implanted neurostimulators.

• 95983,95984 – Implant of brain stimulator

• 95977 complex (adjustment of more than 3 parameters) programming of implanted


neurostimulators.
• Parameters : contact group, amplitude, pulse, width, frequency, dose lockout etc…

• Less than 8 minutes is not separately reportable.

• Programing neuro stimulator in operation theatre is not inherent in service – reported by


implanting surgeon or other qualified professional.
Medicine
• Central Nervous System Assessments/Tests including 96112 and 91113 for
developmental test administration based on time.
• Includes codes based on cognitive services (unit/evaluation/interactive feedback), Test
administration (professional & staff) & Interpretation on automated result

• Add on code 96121 for a neuro behavioral status examination for ab


additional hour was added.

• Under Testing Evaluation Services CPT codes 96130-96133 were added for
neuropsychological testing evaluation services based on time.
Medicine
• 96136-96139 - Psychological or neuropsychological report testing and
scoring.

• Codes are based on time and whether the service was performed by a
technician or clinician.

• 96146 - Psychological or neuropsychological automated testing using an


electronic platform.

• Eight new CPT codes 97151-97158 and guidelines were added to Adaptive
Behavioral services to address deficient adaptive behaviors.
Medicine
• 97151: Behavior identification assessment, administered by a physician or other
qualified healthcare professional, each 15 minutes of the physician’s or other
qualified healthcare professional’s time face-to-face with patient and/or
guardian(s)/caregiver(s) administering assessments and discussing findings and
recommendations, and non face-to-face analyzing past data, scoring/interpreting
the assessment, and preparing the report/treatment plan.
• 97152: Behavior identification supporting assessment, administered by one
technician under the direction of a physician or other qualified healthcare
professional, face-to-face with the patient, each 15 minutes.
• 97153: Adaptive behavior treatment by protocol, administered by a technician
under the direction of a physician or other qualified healthcare professional, face-
to-face with one patient, every 15 minutes.
• 97154: Group adaptive behavior treatment by protocol, administered by a
technician under the direction of a physician or other qualified healthcare
professional, with two or more patients, every 15 minutes.
Medicine
• 97155: Adaptive behavior treatment with protocol modification, administered by a
physician or other qualified healthcare professional, which may include
simultaneous direction of a technician, face-to-face with one patient, every 15
minutes.
• 97156: Family adaptive behavior treatment guidance, administered by a physician
or other qualified healthcare professional (with or without the patient present),
face-to-face with guardian(s)/caregiver(s), every 15 minutes.
• 97157: Multiple-family group adaptive behavior treatment guidance, administered
by a physician or other qualified healthcare professional (without the patient
present), face-to-face with multiple sets of guardians/caregivers, every 15 minutes.
• 97158: Group adaptive behavior treatment with protocol modification,
administered by a physician or other qualified healthcare professional, face-to-face
with multiple patients, every 15 minutes.
Medicine
• The revised Category III codes are:
• 0362T: Behavior identification supporting assessment, every 15 minutes of
technicians’ time face-to-face with a patient, requiring the following components:
• administered by the physician or other qualified healthcare professional who is on site;
• with the assistance of two or more technicians;
• for a patient who exhibits destructive behavior;
• completed in an environment that is customized to the patient’s behavior.
• 0373T: Adaptive behavior treatment with protocol modification, every 15 minutes
of technicians’ time face-to-face with a patient, requiring the following
components:
• administered by the physician or other qualified healthcare professional who is on site;
• with the assistance of two or more technicians;
• for a patient who exhibits destructive behavior;
• completed in an environment that is customized, to the patient’s behavior.
Medicine
• 0362T:
• Physician not required on site
• 1 technician
• Include functional behavior assessment & analysis

• 97152:
• Required on site
• 2 or more technicians
• Destructive behavior
• Include functional behavior assessment & analysis
• Environment customized to patient and behaviour