Master 2020 CPT Changes With This Expert Overview
AAPC’s coding expert Raemarie Jimenez gives you the scoop on next year’s updates.
Code update season is always an exciting time of year. With it brings new, revised, and deleted CPT® codes and coding guidelines that are effective Jan. 1, 2020. There are a lot of CPT changes to learn about: The CPT® 2020 code book includes 314 new codes, 76 revised codes, and 97 deleted codes. All sections of CPT® received changes in codes and guidelines, except Anesthesia. The most significant changes are to codes for fat grafting, insertion of drug delivery during orthopedic procedures, nasal endoscopy, molecular pathology, and electroencephalogram (EEG) monitoring services. Here is an overview by section.
Revised guidelines now instruct coders not to use bilateral modifier 50 with add-on codes. 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. This guideline revision applies to both professional and outpatient facility services.
Modifier 63 was revised to include Medicine section codes that can be reported with this modifier when performed on infants less than 4 kg.
Evaluation and Management (E/M)
New time-based codes (99421, 99422, 99423) have been created to report online digital E/M services. The services are patient-initiated and must use HIPAA-compliant platforms for communication with the provider. Guidelines are included to provide direction for how often the service can be reported and the documented work required by the provider to support the codes. With the creation of the new codes, 99444 for online evaluation and management services was deleted.
Codes for self-measured blood pressure by the patient have been added to the Digitally Stored Data Services/Remote Physiologic Monitoring subsection of the Non-Face-to-Face Services subheading. CPT® 99473 is used to report patient education, setup, and device calibration. The provider will receive the self-measured data from the patient or caregiver and analyze it. 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.
The code for remote physiologic monitoring treatment management services (99457) is revised to be time-based, requiring 20 minutes. A new add-on code (+99458) is created for each additional 20 minutes.
Surgery: Integumentary System
The guidelines for intermediate repairs (12031-12057) and complex repairs (13100-13160) have been revised to provide a clearer description of what is required for undermining. Intermediate repairs include limited undermining, which 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, which 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. 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).
Surgery: Musculoskeletal System
New codes have been created to report needle insertion into a muscle(s) without injection. The new codes are reported based on the number of muscle(s) in which needle(s) are inserted. Code 20560 is reported for one to two muscles, and 20561 is reported for three or more muscles.
Six new codes (20700-20705) have been created 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. These services are add-on codes, which are always reported in conjunction with other procedures. Parenthetical notes are included to indicate the primary codes with which the add-on codes can be reported.
Surgery: Respiratory System
Nine of the nasal/sinus endoscopy codes (31233, 31235, 31292, 91293, 31294, 31295, 31296, 31297, and 31298) are editorially revised, and parenthetical notes are added for more consistent code descriptors and to clarify use. The exclusionary parenthetical notes provide a list of codes that should not be reported when the procedures are performed on the same side.
Surgery: Cardiovascular System
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 now three pericardial drainage codes:
- 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.
- 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.
- 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.
Surgery: 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.
Surgery: Male Genital System
Orchiopexy code 54640 is revised to allow the reporting of a hernia repair when the services are performed during the same surgical session. Previously, the code descriptor included “with or without hernia repair,” which contradicted the parenthetical note stating to report the hernia repair separately.
Surgery: Nervous System
Spinal puncture codes 62270 and 62272 are now parent codes for two new codes created to report spinal puncture with imaging guidance. When fluoroscopy or CT guidance is used during a diagnostic spinal puncture, report 62328. When fluoroscopy or CT guidance is used during a therapeutic spinal puncture, report 62329.
The nerve injection code family went through an overhaul with 18 codes revised, three codes deleted, and two codes added. The parent code is revised to “injection(s),” which clarifies the code is only reported once when multiple injections are performed on the same nerve. The parent code is also revised to include steroids; previously, the code descriptor only included anesthetic agents.
Diagnostic imaging code 74022 has been revised to specify that two or more views are required for a complete acute abdomen series.
The Gastrointestinal Tract subsection received an overhaul, as well, resulting in the deletion of five codes and the creation of two new codes. The changes made in this subsection describe the work done for these procedures, as well as the limitations for reporting the codes.
There are five new codes added and three codes revised for myocardial imaging positron emission tomography (PET) perfusion studies. The changes to this code family better describe how the imaging is performed.
Pathology and Laboratory
New codes have been added to the therapeutic drug assays codes. The new codes include 80145 (adalimutab), 80230 (infliximab), 80235 (lacosamide), 80187 (posaconazole), 80280 (vedolizumab), and 80285 (voriconazole).
Due to frequent use, there are molecular pathology Tier 2 codes that received Tier 1 codes. A few examples include 81277, 81307, and 81308.
There are many new proprietary laboratory analyses (PLA) codes. These codes describe proprietary clinical laboratory analyses and can be either provided by a single laboratory or licensed or marketed to multiple providing laboratories. This subsection includes multianalyte assays with algorithmic analyses (MAAA) and genomic sequencing procedures (GSP).
There is a new influenza vaccine code (90694) to report a quadrivalent, inactivated, adjuvanted, preservative-free vaccine that is administered intramuscularly.
Codes for retinal drawing (92225, 92226) are deleted, and two new codes (92201, 92202) have been created. Previously the codes were reported based on whether the service is initial or subsequent. Because the work performed does not change based on whether it is initial or subsequent, new codes were created to better describe the work.
Extensive changes have been made to the codes for long-term EEG monitoring services. Codes 95950, 95951, 95953, and 95956 are deleted, and 23 new codes (95700-95726) are added. The guidelines are revised, and new guidelines are added. Two new subsections under Special EEG Tests are added. A new table is also added for long-term EEG monitoring services to provide instructions for proper code use.
Learn More About CPT® Updates
For training and application of the CPT® code changes for 2020, please join us for AAPC’s annual CPT® Update webinar on Nov. 26 or hands-on virtual workshop on Dec. 3.