Any Way You Spin It, CPT® 2019 will Surprise You
Nearly every section in the code book has updates: The stakes are high that your coding is affected.
CPT® 2019 includes 212 new Category I and III codes, 50 revised code descriptors, and 71 deleted codes — plus revised introductory guidelines, and new and revised parenthetical references. Nearly every section of the code book (except anesthesia and Category II codes) receives significant updates. You’ll find major changes in the reporting of remote patient monitoring, fine needle aspiration, skin biopsy, peripherally inserted central venous catheters, molecular pathology, medicine services, and emerging technologies. Here’s a review of what CPT® 2019 holds.
Guideline Change for Modifier 63
New guidelines allow you to append modifier 63 Procedure performed on infants less than 4 kgs with Medicine/Cardiovascular (90000-series) codes to describe increased complexity of procedures performed on patients of less than 4 kg (approx. 8.8 lbs.). Per CPT® Changes 2003: An Insider’s Guide,
In this population of patients, there is a significant increase in work intensity, specifically related to temperature control, obtaining IV access (which may require upwards of 45 minutes) and the operation itself, which is technically more difficult, especially with regard to maintenance of homeostasis.
CPT® disallows modifier 63 with many codes that describe procedures involving congenital anomalies, and those valued to reflect heightened complexity associated with prematurity. You can find a complete list of modifier 63 exempt codes in Appendix F of CPT®.
Evaluation and Management (E/M) Services
CPT® 2019 introduces two new codes to report remote physiologic monitoring services (e.g., weight, blood pressure, pulse oximetry) during a 30-day period: one for device setup and patient education (99453), and a second for supply of the device with daily recording or programmed alert transmissions (99454).
Also added is 99457 to report remote physiologic monitoring treatment management services. Per CPT®, these services “are provided when clinical staff/physician/other qualified health care professional use the results of remote physiological monitoring to manage a patient under a specific treatment plan.” The code describes “time spent managing care when patients or the practice do not meet the requirements to report more specific services.”
A new, time-based chronic care management code (99491) describes the work of a qualified provider to establish, implement, revise, or monitor the care plan for a patient with two or more chronic continuous or episodic health conditions that are expected to last at least 12 months (or until the death of the patient) and put the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline.
CPT® 2019 will include a single code to report fine needle aspiration (FNA) of an initial lesion without imaging guidance (10021, which has been revised) and four new codes (10004-10007) to report FNA of an initial lesion using specified imaging modalities including ultrasound, fluoroscopy, computed tomography (CT), and magnetic resonance imaging (MRI). Add-on codes (10008-10012) will report FNA for each additional lesion targeted beyond the first, depending on whether (and what type of) imaging guidance is used. You can “mix and match” the primary and add-on codes in any combination necessary to report medically-necessary services, as provided. You may not separately report imaging with any of the new FNA codes.
Six new codes are added to describe biopsy by various techniques:
- 11102, +11103 describe tangential biopsy. CPT® 11102 is for a biopsy of a single lesion and add-on code 11103 is for each additional lesion biopsied, beyond the first. A tangential biopsy is performed with a sharp blade to remove a sample of epidermal tissue (which may include some underlying dermis).
- 11104, +11105 describe punch biopsy. Punch biopsy requires a punch tool to remove a full-thickness cylindrical sample of skin and includes simple closure of the defect. CPT® 11104 describes biopsy of a single lesion, and add-on code 11105 describes each additional lesion biopsied.
- 11106, +11107 describe incisional biopsy. Incisional biopsy is performed using a sharp blade to remove a full-thickness sample of tissue via a vertical incision or wedge, penetrating deep to the dermis, into the subcutaneous space. CPT® 11106 describes biopsy of an initial lesion by this method, and add-on code 11107 describes additional lesions targeted by incisional biopsy.
You may combine the new codes to report biopsy by various methods.
New add-on codes will allow clinicians to report osteoarticular (20932), hemicortical (partial) intercalary (20933), and complete intercalary (20934) allografts in addition to tumor removal procedures.
Code 27369 is added to describe contrast knee arthrography or contrast enhanced CT/MRI knee arthrography.
New codes are added to describe implantation (33274) and removal (33275) of permanent leadless pacemakers, as well as the implantation (33285) and removal (33286) of subcutaneous cardiac rhythm monitor, and implantation of a wireless pulmonary artery pressure sensor (33289).
Code 33440 is added to describe the Ross-Konno procedure (a method of aortic valve replacement).
New add-on code 33866 reports aortic hemiarch graft when performed in addition to an ascending aortic graft (33860, 33863, or 33864), when ascending aortic disease involves the aortic arch.
Codes for peripherally inserted central venous catheter (PICC) lines will experience a refresh for 2019. Existing codes 36568 (younger than age 5) and 36569 (age 5 and older) are revised to report PICC placement without subcutaneous port or pump, and without imaging guidance. Two new codes —one for a patient younger than age 5 (36572) and the second for age 5 and older (36573) — are added to describe PICC line procedures that bundle imaging guidance, image documentation, and all associated radiological supervision and interpretation. The codes include documentation of evaluation of the potential puncture sites, patency of the entry vein, real-time ultrasound visualization of needle entry into the vein, and confirmation of catheter tip location. If confirmation of the catheter tip location is not performed, CPT® tells us to report a reduced service.
Hemic and Lymphatic System
Code 38531 is added to report open biopsy or excision of inguinofemoral lymph node(s), which are located near the groin.
Code 43760 is deleted and replaced by two new codes that define simple versus complex replacement of a percutaneous gastrostomy tube: 43762 for percutaneous replacement of gastrostomy tube without imaging or endoscopy and 43763 for percutaneous replacement of gastrostomy tube with removal when performed without imaging or endoscopy.
Code 50395 is deleted and replaced by two new codes: 50436 describes enlargement of an existing percutaneous tract to the renal collecting system to allow the use of instruments used during an endourologic procedure; 50437 reports the same service with the addition of new access into the renal collecting system during the same session, if there is no pre-existing tract.
New code 53854 describes the use of radiofrequency energy to transform sterile water into vapor (steam). The resulting thermal energy is used to destroy obstructive prostate tissue cells.
Codes +61641 and +61642, which describe dilatation of intracranial vasospasm, have revised descriptors, but the application of these codes is not affected.
Several codes within the nervous system are deleted due to low utilization. In the rare case you need to report a deleted service, revert to an unlisted procedure code.
Added codes 76978-76979 report ultrasound procedures that use dynamic microbubble-sonographic contrast with targeted ultrasound to evaluation lesions. Report 76978 for the initial lesion targeted and +76979 (with 76978) to report additional lesion(s) targeted, beyond the first.
Three new codes report ultrasound elastography (USE), which works on the principle that abnormal tissue (e.g., a neoplasm) is “stiffer” than normal tissue, and may be identified by ultrasound elastography:
- 76981, parenchyma (i.e., the functional parts of a body organ)
- 76982, first target lesion
- +76983, for each additional target lesion (reported a maximum of two units per session)
Existing breast MRI codes 77058 and 77059 are deleted. In their place, CPT® 2019 introduces four new codes for breast MRI:
- 77046: Unilateral (MRI imaging of one breast)
- 77048: Unilateral (MRI imaging of one breast) with contrast
- 77047: Bilateral (MRI imaging of both breasts) without contrast
- 77049: Bilateral (MRI imaging of both breasts) with contrast
Pathology and Laboratory
Due to frequent use, many services previously classified within “Tier 2” molecular pathology codes are now described using standalone “Tier 1” codes (examples include 81171-81172 and 81173-81183).
BRCA1 and BRCA2 testing codes (e.g., hereditary breast cancer) are revised due to changes in clinical practice and to standardize molecular pathology code structure.
A new vaccine product for influenza virus gains a code, 90689.
Code 92275 is deleted and replaced by three new codes for electroretinography (ERG). Per CPT®, ERG:
is used to evaluate function of the retina and optic nerve of the eye, including photoreceptors and ganglion cells. A number of techniques are used which target different areas of the eye, including full field (flash and flicker) (92273) for a global response of photoreceptors of the retina, multifocal (92274) for photoreceptors in multiple separate locations in the retina including the macula, and pattern (0509T) for retinal ganglion cells.
New code 95836 describes recording of electrocorticogram (ECoG) from electrodes chronically implanted on or in the brain, and includes unattended recording with storage for later review and interpretation during a 30-day period.
A group of new codes (95976-95984) describe services related to implanted neurostimulator pulse generator/transmitter.
A new subsection for Adaptive Behavior Services is added, with the conversion of Category III codes 0359T, 0360T, 0361T, 0363T, 0364T-0372T, and 3747T to time-based Category I codes. These services include:
- Behavior identification assessment (97151 and 97152);
- Adaptive behavior treatment by protocol (97153 and 97154);
- Adaptive behavior treatment with protocol modification (97155);
- Family adaptive behavior treatment guidance (97156 and 97157); and
- Group adaptive behavior treatment with protocol modification (97158).
Two new, time-based codes describe developmental test administration (96112, first hour and +96113, each additional 30 minutes). These services must include an interpretation and report when performed by a qualified provider.
Codes 96130, +96131, 96136, +96137, 96138, +96139, 96146 are added to report time-based, psychological testing evaluation and administration and scoring services.
Category III Codes
Category III codes report emerging technologies and allow for data tracking. If a Category III code is available, you must use it in place of a Category I unlisted procedure code.
New Category III codes 0512T and +0513T report extracorporeal shock wave therapy (ESWT), a non-surgical treatment that involves the delivery of shock waves to musculoskeletal areas to reduce pain and promote healing of the affected soft tissue (existing codes 0101T and 28890 are used to report ESWT to the musculoskeletal system and plantar fascia, respectively).
Revised code 0335T describes extra-osseous (lateral aspect) implantation of a subtalar implant to stabilize a talotarsal displacement (partial dislocation of the ankle bone on the heel bone). Two new codes describe removal (0510T) and removal and reinsertion (0511T) of sinus tarsi implant.
Codes 0515T-0523T are added to report services related to wireless cardiac stimulator system (e.g., insertion of various components, device programming, etc.), which provides biventricular pacing of the heart using a previously implanted pacemaker or defibrillator and a wireless electrode implanted on the endocardium of the left ventricle.
Similarly, new codes 0525T-0532T describe services related to intracardiac ischemia monitoring system, an implantable electrogram device that records cardiac data and detects ischemic events by way of an intracardiac lead in the right ventricular apex. The system provides a warning if it detects an impending acute ischemic event to help reduce the time from ischemic event onset to the onset of care.
Parkinson’s KinetiGraph™ (PKG™) gains several codes, 0533T-0536T, for patient setup and training, data analysis, etc. The PKG is a passive, wearable device that continuously measures and tracks the movements of patients with Parkinson’s disease. The resulting data is used to manage patient care and treat symptoms such as bradykinesia, dyskinesia, and tremor.
Two codes now report magnetocardiography (MCG), a non-invasive technique to measure and map magnetic fields produced by electrical activity in the heart. MCG is more sensitive to weak cardiac signals than is ECG, which is beneficial when diagnosing ischemic heart disease (IHD).
Code 0541T describes the technical portion of an MCG study (e.g., performance of the test using equipment as specified in the code descriptor), while 0542T describes the related interpretation and report (i.e., the professional portion of the service).
There’s More to Learn!
This is only a summary of changes to CPT® 2019. For a complete rundown of the new, revised, and deleted codes and guidelines, sign up for AAPC’s comprehensive 2019 CPT® Coding Updates Virtual Workshop, which airs “live” on Dec. 6 and is available on demand starting Dec. 7.
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