2020 CPT Coding Updates Written By: Ginger Avery, CPC, CPMA, CRC Coding & Compliance Manager It’s that time of the year again! The new CPT®2020 code changes take effect January 1st and are based on input from clinicians, medical societies and the greater health care community. Understanding the myriad of upcoming changes is crucial to obtaining the proper reimbursement for your services! The changes for 2020 address a number of interrelated issues. Clinical practice and technology have evolved and several issues required much needed CPT expansion and clarification. CPT®2020 offers changes that affect nearly every specialty. *Please note, this article is not an all-inclusive list; review your CPT®2020 book for complete descriptions of all changes. Appendix B on page 816 of AMA’s CPT®2020 provides a summary of additions, deletions, and revisions. Watch for green text throughout the code book for new information! The American Medical Association’s (AMA’s) 2020 update of the CPT code set comprises 394 code changes, including 248 new codes, 71 deletions, and 75 revisions. Aside from anesthesia, all sections of CPT received changes in codes and guidelines. Highlights of the most significant changes are as follows: Introduction Changes (see CPT®2020 pg xvi): • Code Symbols update: “…even though the PLA section is located at the end of the pathology and laboratory section of the codes set, a PLA code does not fulfill Category I code criteria.” • Add-on Codes concept updated: “…when the add-on procedure can be reported bilaterally and is performed bilaterally, the appropriate add-on code is reported twice…Do not report modifier 50 in conjunction with add-on codes…See the definitions of modifier 50 and 51 in Appendix A.” Changes to the Appendices (see CPT®2020 Pg 809) Appendix A: Modifiers • Modifier 50: This modifier should not be appended to designated “add-on” codes (see Appendix D). If an additional or supplemental procedure is performed bilaterally, report the add-on code twice using the RT and LT modifiers to indicate laterality, rather than modifier 50. • Modifer 63: Should not be appended to any CPT codes listed in the Evaluation and Management Services, revised to include medicine section codes that can be reported. Appendix E: CPT Codes Exempt from Modifier 51 • Updated list of CPT codes exempt from modifier 51 Evaluation and Management Changes (see CPT®2020 pg 38-56) • Preventive • Do not report HBAI’s with Behavior Change Interventions • Non-Face-to-Face Services • Telephone Services (99441-99443) • Remote Physiologic Monitoring Treatment Management Services (99457-99458) was revised to be time-based. • • • • E-visits: Six new CPT codes for reporting a range of digital health services including e-visits through secure patient portal messages. • Time based codes 99421, 99422 and 99423 have been created to describe patientinitiated digital communications with a physician or other qualified health professional • 98970, 98971 and 98972 represent patient-initiated digital communications with a nonphysician health professional New codes 99473 and 99474 allow reporting self-measured blood pressure monitoring (pg 42). • CPT 99473 is used to report patient education, setup, and device calibration. • To report 99474, a minimum of 12 recordings must be reviewed, and the provider must render an interpretation that includes average systolic and diastolic pressures and communication with the patient on the treatment plan. Chronic Care Management (CCM) guideline update. Transitional Care Management (TCM) guideline update. Surgery Section Updates Integumentary • The guidelines for intermediate and complex repairs (12031 – 13160) have been revised to provide a clearer description of what is required for undermining. Intermediate repairs include limited undermining, CPT describes as “a distance less than the maximum width of the defect, measured perpendicular to the closure line, along at least one entire edge of the defect.” Complex repairs include extensive undermining, CPT describes as “a distance greater than or equal to the maximum width of the defect, measured perpendicular to the closure line along at least one entire edge of the defect.” • New guidelines are also added in each of the subsections for breast procedures (19000 – 19303). Extensive review of these subsections is required. In addition, code 19304 is deleted due to low utilization. Parenthetical notes are added to direct you to the correct codes for this service. • New autologous grafting codes have been created. Code 15769 is reported for soft tissue harvested by direct excision. Codes for the harvesting of fat by liposuction are reported based on anatomic site and amount of fat removed. Harvesting codes are reported by the recipient site of the graft, not the donor site. • • • Codes 15771 and +15772 are reported for fat harvested via liposuction for defects of the trunk, breasts, scalp, arms, and/or legs. Code 15771 includes 50 ccs or less, and +15772 is an add-on code for each additional 50 ccs or part thereof. Codes 15773 and +15774 are reported for fat harvested via liposuction for defects of the face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet. Code 15773 includes 25 ccs or less, and +15774 is an add-on code for each additional 25 ccs or part thereof. Codes for the excision for chest wall tumors (19260, 19271, 19272) are deleted and replaced with new codes in the Musculoskeletal System section (21601, 21602, 21603). Musculoskeletal System New codes have been created to report needle insertion into a muscle(s) without injection. Code 20560 is reported for one to two muscles, and 20561 is reported for three or more muscles. Six new add-on codes (20700-20705) are now available to report the manual preparation and insertion of drug delivery devices and the removal of the devices. The manual preparation includes the mixing of agents and placing them on the delivery device such as nails, beads, or spacers. Parenthetical notes are included to indicate the primary codes with which the add-on codes can be reported. Respiratory Nine nasal/sinus endoscopy codes (31233, 31235, 31292, 91293, 31294, 31295, 31296, 31297, and 31298) are revised. Parenthetical notes have been added for more consistent code descriptors and to clarify use. Cardiovascular • Codes for pericardiocentesis (33010, 33011, 33015) are deleted and replaced with new codes. Pericardiocentesis is no longer coded based on initial or subsequent service. There is now one code for pericardiocentesis (33016), which includes imaging guidance when performed; and there are three new pericardial drainage codes: o 33017 is for pericardial drainage with the insertion of an indwelling catheter on patients 6 years and older. The procedure includes fluoroscopy or ultrasound guidance when performed. • • • o 33018 is for pericardial drainage with the insertion of an indwelling catheter on patients 5 years old and under, or patients of any age with a cardiac anomaly. The procedure includes fluoroscopy or ultrasound guidance when performed. o 33019 is for pericardial drainage with the insertion of an indwelling catheter when computed tomography (CT) guidance is used. This code is not age-specific. Ascending aorta graft code 33860 is deleted and replaced by two new codes: 33858 and 33859. When the procedure involves aortic dissection, use 33858. If performed for aortic disease other than dissection, use 33859. The transverse arch graft code (33870) is deleted and replaced with 33871. The descriptor is revised to better describe the service as it is performed now. Pacers or Implantable Defibrillators & device evaluation code instructions Digestive System • The descriptors for internal hemorrhoidectomy codes 46945 and 46946 are revised to include “without imaging guidance.” Category III code 0249T is deleted and replaced with Category I code 46948 to report an internal hemorrhoidectomy by transanal hemorrhoidal dearterialization, which is a less invasive procedure than the traditional hemorrhoidectomy. Nervous System • Injection, Drainage or Aspiration updates (see codes 62270-62273 & 62328-62329) Medicine Section Changes new influenza vaccine code (90694) to report a quadrivalent, inactivated, adjuvanted, preservative-free vaccine that is administered intramuscularly. See specific updates in CPT®2020 for the following bullets: • Implantable, Insertable, and Wearable Cardiac Device Evaluations • New add-on code for myocardial strain imaging 93356 • Cardiac Catheterizations (93451 – 93462) • Arterial & arterial venous studies (93925-93990) • DIY Blood pressure monitoring (99473 – 99474) • Counseling/Risk Factor Reduction • Updates for health and behavior assessment and intervention services: New codes 96156, 96158, 96164, 96167, and 96170, and add-on codes 96159, 96165, 96168, and 96171 for health and behavior assessment and intervention services will replace six older codes. According to the AMA, this update is intended to “more accurately reflect current clinical practice that increasingly emphasizes interdisciplinary care coordination and teamwork with physicians in primary care and specialty settings.” • Significant changes for reporting long-term electroencephalographic (EEG) monitoring services (95700-95726): Monitoring the electrical activity of the brain is critical to diagnose epilepsy. Four older codes have been deleted to make way for 23 new codes for long-term electroencephalographic (EEG) monitoring services. According to the AMA, the new codes provide better clarity around the services reported by a technologist, a physician, or another qualified health care provider. As a reminder, with ALL services, the purpose of documentation is to tell an excellent story about each individual encounter. Why is the patient here today (what is the presenting problem), what are the observations, what is the clinical impression/plan of care? Focusing documentation on clinically relevant details for the unique services provided creates clear notes that help to support excellent patient care, creates clear collaboration between professionals and supports medical necessity for the services reported. RT Welter’s team of expert coders can help clinicians report the correct codes and ensure proper reimbursement for their services. We provide ongoing education and update our clients with changes to codes and reporting requirements, as well as provide documentation pointers to ensure clinician documentation is legible, complete, and accurate to help with timely reimbursement. Coding compliance plans, external audits and annual clinician education is required by the ACA! Contact us today to get started!
