navicure webinar: 2018 cpt coding changes · 2018 cpt coding changes ... to the ama cpt editorial...

2018 CPT Coding ChangesPresented by Betsy Nicoletti, M.S., CPC

© 2017 Navicure, Inc. All Rights Reserved.

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CPT book Appendix B

• At a glance, additions, deletions and revisions

• CPT Professional Edition in color, easily shows

revised descriptions, new codes, revised text

and editorial comments that are changed are in

green

• For multi-specialty groups or changes in your

services, buy CPT 2018 Changes An Insider’s

View

o Gives rationale and clinical examples

©2017 Betsy Nicoletti

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Symbol review

At the bottom of each page of CPT:

• Red circle=new code

• Blue triangle=revised code

• Sideways triangles=new or revised text

• Star=telemedicine

• Plus sign=add on code

• #=resequenced code

• Lightening bolt=pending FDA approval


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Bundling

• Yearly, codes reported together more than 75%

of the time are referred to the AMA CPT Editorial

Panel

• New codes created to describe services

frequently reported together, new RVU values

• This year, endovascular repair of aorta and

endovenous ablation of incompetent veins


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E/M section

• Observation code descriptions changed from

“admission to observation status” to “outpatient

hospital observation status”

• Change for initial OBS and discharge codes,

99218—99220 and 99217

• Domiciliary, rest home, or custodial care now

include “group home, custodial care and

intermediate care facilities”


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E/M section

• Anti-coagulation management codes 99363,

99364 deleted

o New codes in medicine chapter

• 93792 Patient/caregiver training for initiation of

home INR monitoring (national payment ~ $55)

• 93793 Anticoagulant management for patient

taking warfarin (national payment ~ $12)

• Have status indicator of ACTIVE in Medicare fee

schedule


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Neonatal and pediatric critical care

• Text added to clarify that when reporting per

day neonatal critical care codes, a physician in

same specialty may not report 99291 or 99292

• Physicians of other specialties may report

99291 and 99292 for care of critically ill

neonate or child


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New codes in E/M section

• 99483 replaces HCPCS code G0505



• +99494 replaces HCPCS code G0504

• #99484 replaces HCPCS code G0507


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Cognitive assessment

99483 Assessment and care planning for a

patient with cognitive impairment, requiring an

independent historian, in the office or other

outpatient, home or domiciliary or rest home

• Typical time of 50 minutes assigned

• May only be reported once in every 180 days

• CMS stated physician/NP/PA


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99483 Cognitive assessment

• Assessment of patient with Alzheimer’s or

dementia at any stage of impairment

• Cognition-focused evaluation including history

and exam, moderate or high MDM

• Functional assessment including decision

making capacity

• Use of standardized instrument to stage

dementia

• Requires care plan development


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Psychiatric Collaborative Care Management

services

• Direction by physician or qualified health care

professional (QHCP) of behavioral health

manager in a calendar month

• Requires a psychiatric consultant who does

not need to see the patient but consults with

PCP team


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99492

• 99492 Initial psychiatric collaborative care

management, first 70 minutes in the first

calendar month of behavioral health care

manager activities, in consultation with a

psychiatric consultant, and directed by the

treating physician or other qualified health care

professional


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99493

• 99493 Subsequent psychiatric collaborative

care management, first 60 minutes in a

subsequent month of behavioral health care

manager activities, in consultation with a

psychiatric consultant, and directed by the

treating physician or other qualified health care

professional


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99494

• 99494 Initial or subsequent psychiatric

collaborative care management, first 30

minutes in the first calendar month of

behavioral health care manager activities, in

consultation with a psychiatric consultant, and

directed by the treating physician or other

qualified health care professional

• Use 99494 in conjunction with 99492, 99493


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Code for clinical staff/BHI

99484 Care management services for behavioral

health conditions, at least 20 minutes of clinical

staff time, directed by a physician or other

qualified health care professional time, per

calendar month.

• Lower payment, but less time

• Doesn’t require behavioral health manager or

psychiatric consultation

• Clinical staff time


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Anesthesia new codes

• 00731 Anesthesia for upper gastrointestinal endoscopic

procedures, endoscope introduced proximal to

duodenum; not otherwise specified

• 00732 ERCP

• 00811 Anesthesia for lower intestinal endoscopic

procedures, endoscope introduced distal to duodenum,

not other specified

• 00812 Screening colonoscopy

• 00813 Anesthesia for combined upper and lower GI

endoscopic procedures, endoscope introduced both

proximal and distal to the duodenum


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Anesthesia

Deleted codes

• 00740 Anesthesia for procedures on upper anterior

abdominal wall; not otherwise specified

• 00810 Anesthesia for lower intestinal endoscopic

procedures, endoscope introduced distal to duodenum.

• 01180 Anesthesia for obturator neurectomy; extrapelvic

• 01190 Anesthesia for obturator neurectomy; intrapelvic

• 01682 Anesthesia for shoulder cast application, removal

or repair; shoulder spica


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Skin

New codes

• 15730 Midface flap (ie, zygomaticofacial

flap)with preservation of vascular pedicle (s)

• 15733 Muscle, myocutaneous, or

fasciocutaneous flap; head and neck with

named vascular pedicle (i.e. buccinators,

genioglossus, temporalis, masseter,

sternocleidomastoid, levator scapulae)


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Skin

• +19294 Preparation of tumor cavity, with

placement of a radiation therapy applicator for

intraoperative radiation therapy (IORT)

concurrent with partial mastectomy. Use 19294

with 19301, 19302

• Parenthetical notes added to some

mastectomy codes to preclude reporting

intraoperative placement of clip(s) separately


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Skin

Revised code

• 17250 Chemical cauterization of granulation tissue (ie,

proud flesh)

o No longer includes words “sinus or fistula”

• Deleted - 15732 Muscle, myocutaneous, or

fasciocutaneous flap; head and neck (e.g., temporalis,

masseter muscle, sternocleidomastoid, levator

scapulae)


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Musculoskeletal

• New code: +20939 Bone marrow aspiration for

bone grafting, spine surgery only, through

separate skin or fascial incision

• Use with 22319, 22532, 22533, 22534, 22551,

22552, 22554, 22556, 22558, 22590, 22610, 22612,

22630, 22633, 22634, 22800, 22802, 22804, 22808,

22810, 22812)

• May report bilaterally

• Deleted codes 29582, 29583


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Nasal sinus endoscopy codes

New codes

• 31241 Nasal/sinus endoscopy, surgical; with ligation

of sphenopalatine arter

• 31253 Nasal/sinus endoscopy, surgical with

ethmoidectomy; total (anterior and posterior),

including frontal sinus exploration, with removal of

tissue from frontal sinus, when performed

• 31257 total (anterior and posterior), including

sphenoidotom

• 31259 total (anterior and posterior), including

sphenoidotomy, with removal of tissue from the

sphenoid sinus©2017 Betsy Nicoletti

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Nasal sinus endoscopy codes

New codes

• 31298 Nasal/sinus endoscopy, surgical; with

dilation of frontal and sphenoid sinus ostia (eg,

balloon dilation) Revised codes

• 31254 Nasal/sinus endoscopy, surgical with

ethmoidectomy; partial (anterior)

• 31255 Total (anterior and posterior)

• 31276 Nasal/sinus endoscopy, surgical, with frontal

sinus exploration, including removal of tissue from

frontal sinus, when performed


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Respiratory section

Revised codes

• 31645 Bronchoscopy, rigid or flexible, including

fluoroscopic guidance, when performed; with

therapeutic aspiration of tracheobronchial tree,

initial

• 31646 with therapeutic aspiration of

tracheobronchial tree, subsequent, same

hospital stay


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Respiratory system

New code, out of sequence

• # 32994 Method of ablation: ablation therapy

by cryoablation differentiated from

radiofrequency ablation therapy

• 32998 Ablation therapy for reduction or

eradication of 1 or more pulmonary tumor(s)

including pleura or chest wall when involved by

tumor extension, percutaneous, including

imaging guidance when performed, unilateral;

radiofrequency


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Heart/lung transplantation

Three new codes—replaced Category III codes

0051T—0053T

• 33927 Implantation of a total replacement heart

system (artificial heart) with recipient cardiectom

• 33928 Removal and replacement of total

replacement heart system (artificial heart)

• +33929 Removal of a total replacement heart

system (artificial heart) for heart transplantation (List

separately in addition to code for primary

procedure)


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Endovascular repair of abdominal

aorta and/or iliac arteries

• New codes in series 34701—34812

• Two out of sequence codes in this section

34833, 34834

• 8 deleted codes, 4 revised and 16 new codes

• Major new section and explanation in

cardiovascular section

• Visit this link for listing of these codes


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http://info.navicure.com/rs/669-OIJ-380/images/Endo codes new_revised.pdf

Endovascular changes

• New codes bundle related services into repair,

including pre-procedure sizing and device

selection, non-selective catheterizations and

radiological supervision and interpretation

• Codes for repair of iliac artery, exposure of the

femoral and iliac arteries for delivery of

endovascular prosthesis


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Revisions to old codes

• 34820, 34833, 34834, 36410, 36468, 36470,

36471

• Revisions to descriptions for consistency with

new codes in series


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Compounding, per CPT

• “Compounding is a practice in which a qualified

health care professional (eg, pharmacist,

physician) combines, mixes or alters ingredients

of a drug to create a medication tailored to the

needs of an individual patient.”

• In office, all five codes next slides include all

required supplies and equipment, & application of

compression bandages/stockings, when

performed.

• Read editorial comments, if performing.


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Revisions for injection of

sclerosant for sclerotherapy

• 36468 Injection(s) of sclerosant for spider veins

(teleangiectasia) limb or trunk

o Report once per extremity per session, regardless of the

number of needle injections performed

• 36470 Injection of sclerosant, single incompetent vein

(other than telangiectasis)

• 36471 Multiple incompetent veins, (other than

telangiectasis), same leg

• Report once per extremity, regardless of # of needle

injections


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Revisions for injection of

sclerosant for sclerotherapy

• Ultrasound guidance (76942) when performed,

is not included in 36468, 36470, 36471 and

may be reported separately


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Injection of a non-compounded

foam sclerosant

• #36465 Injection of non-compounded foam

sclerosant with ultrasound compression maneuvers

to guide dispersion of the injectate, inclusive of all

imaging guidance and monitoring; single

incompetent extremity truncal vein (e.g., great

saphenous vein, accessory saphenous vein)

• #36466 multiple incompetent truncal veins (e.g.,

great saphenous vein, accessory saphenous vein),

same leg


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Endovenous ablation therapy

New codes, out of sequence

• #36482 Endovenous ablation therapy of incompetent

vein, extremity, by transcatheter delivery of a chemical

adhesive (e.g., cyanoacryalte) remote from the access

site, inclusive of all imaging guidance and monitoring,

percutaneous; first vein treated

• #+36483 subsequent vein(s) treated in a single

extremity, each through separate access.

• Use 36483 with 36482; do not report 36483 more than

once per extremity


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More vascular changes

• 36515 deleted; see 36516

• Revised: 36516 Therapeutic apheresis with

extracorporeal immunoadsorption, selective

adsorption or selective filtration and plasma

reinfusion


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Diagnostic bone marrow aspiration

Revised

• 38220 Diagnostic bone marrow; aspiration (s)

• 38221 Diagnostic bone marrow biopsy (ies)

• When aspiration is both diagnostic and biopsy,

report new code

New

• 38222 Diagnostic bone marrow biopsy (ies) and

aspiration(s)


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Lymph nodes

New

• 38573 laparoscopy, Surgical with bilateral total

pelvic lymphadenectomy and peri-aortic lymph

node sampling, peritoneal washings,

peritoneal biopsy(ies), omenectomy, and

diaphragmatic washings, including

diaphragmatic and other serosal biopsy(ies),

when performed


44

Changes in digestive system

Revised code

• 43112 Total or near total esophagectomy, with

throracotomy; with pharyngogastrostomy or

cervical esophagogastrostomy, with or without

pyloroplasty (i.e. McKeown esophagectomy or

tri-incisional esophagectomy)


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New codes

• 43286 Esophagectomy, total or near total,

with laparoscopic mobilization of the

abdominal and mediastinal esophagus and

proximal gastrectomy, with laparoscopic

pyloric drainage procedure if performed, with

open cervical pharyngogastrostomy or

esophagogastrostomy (i.e., laparoscopic

transhiatal esophagectom)


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New code

• 43287 Esophagectomy, distal two-thirds, with

laparoscopic mobilization of the abdominal and

lower mediastinal esophagus and proximal

gastrectomy, with laparoscopic pyloric drainage

procedure if performed, with separate thoracoscopic

mobilization of the middle and upper mediastinal

esophagus and thoracic esophagogastrostomy (i.e.,

laparoscopic thoracoscopic esophagectomy, Ivor

Lewis esophagectomy)


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New Code

• 43288 Esophagectomy, total or near total, with

thoracoscopic mobilization of the upper, middle, and

lower mediastinal esophagus, with separate

laparoscopic proximal gastrectomy, with laparoscopic

pyloric drainage procedure if performed, with open

cervical pharyngogastrostomy or esophagogastrostomy

(i.e., thoracoscopic, laparoscopic and cervical incision

esophagectomy, McKeown esophagectomy, tri-incisional

esophagectom)


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GU, male

• 55450 Ligation of vas deferens deleted

• Use 55250 Vasectomy, unlitateral or bilateral

including post operative semen examinations

New code

• 55874 Transperineal placement of

biodegradable material, peri- prostatic, single or

multiple injection(s), including image guidance,

when performed

• Includes imaging: do not report 76942


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GU, female

• Three codes now “includes cystourethroscopy, when

performed”

• 57240 Anterior colporrhaphy, 57260 combined

anteroposterior colporrhaphy, and 57265 with enterocele

repair

New code

• 58575 Laparoscopy, surgical, total hysterectomy for

resection of malignancy (tumor debulking), with

omentectomy including salpingo-oophorectomy,

unilateral or bilateral, when performed


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Nervous system changes

• 64550 adds (e.g. TENS unit)

• Deleted: 64565 Percutaneous implantation of

neurostimulator electrode array, neuromuscular

New codes

• 64912 Nerve repair; with nerve allograft, each

nerve, first strand (cable)

• +64913 with nerve allograft, each additional

strand (List separately in addition to code for

primary procedure)


51

Inner ear

Two deleted codes

o 69820 Fenestration semicircular canal

o 69840 Revision fenestration operation

• Deleted due to low utilization


52

Radiology changes

• Chest x-ray codes 71010, 71015, 71020,

71021, 71022, 71023, 71030, 71034, 71035

deleted

• New codes added to describe chest x-rays by

number of views (not view-specific descriptors)


53

Radiology changes

• 71045 Radiologic examination, chest; single

view

• 71046 2 views

• 71047 3 views

• 71048 4 or more views


54

Radiology

• Abdominal x-ray codes 74000, 74010, 74020

deleted and three new codes to report number

of views

• 74018 Radiologic examination, abdomen; 1

view

• 74019 2 views

• 74021 3 or more views


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Radiology

• Deleted codes in radiology section due to

changes in endovascular repair of abdominal

aortic aneurysms

• Deleted: 75952, 79563, 75954


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Radiology

Revised descriptions

• 76000 Fluoroscopy (separate procedure), up to 1 hour physician or

other qualified health care professional time

• 76881 Ultrasound, complete joint (i.e., joint space and peri- articular

soft-tissue structures), real-time with image documentation

• 76882 Ultrasound, limited, joint or other nonvascular extremity

structure(s) (e.g., joint space, peri-articular tendon[s], muscle[s],

nerve[s], other soft-tissue structure[s], or soft- tissue mass[es]), real-

time with image documentation

Deleted 77442, 78190


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Pathology and laboratory

• Revised drug testing codes

• 80305 Drug test(s), presumptive, any number

of drug classes, any number of devices or

procedures; capable of being read by direct

optical observation only (e.g., utilizing

immunoassay [e.g., dipsticks, cups, cards, or

cartridges]), includes sample validation when

performed, per date of service


58


Revised drug testing codes

• 80306 read by instrument assisted direct optical

observation (e.g., utilizing immunoassay [e.g., dipsticks,

cups, cards, or cartridges]), includes sample validation

when performed, per date of service

• 80307 by instrument chemistry analyzers (e.g., utilizing

immunoassay [e.g., EIA, ELISA, EMIT, FPIA, IA, KIMS,

RIA]), chromatography (e.g., GC, HPLC), and mass

spectrometry either with or without chromatography,

(e.g., DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-

MS/MS, LDTD, MALDI, TOF) includes sample validation

when performed, per date of service


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• Additional codes for Tier 1 Molecular Pathology

Procedures, representing gene-specific and

genomic procedures

• Edits and additions in Tier 2 Molecular

Pathology codes

• New codes for oncology mRNA expression

testing


60

Pathology and laboratory—new codes

• 86008 Allergen specific IgE; quantitative or

semiquantitative, recombinant or purified

component, each

• 86794 Zika virus, IgM

• 87634 respiratory syncytial virus, amplified

probe technique

• 87662 Zika virus, amplified probe technique

• Additionally some Category III codes added


61

Medicine section

• New vaccines are added to CPT and updated

every six months

• 90756 Influenza virus vaccine, quadrivalent

[ccIIV4], derived from cell cultures, subunit,

antibiotic free, 0.5 mL dosage, for intramuscular

use

• 90682 Influenza virus vaccine, quadrivalent

[RIV4], derived from recombinant DNA,

hemagglutinin [HA] protein only, preservative

and antibiotic free, for intramuscular use


62

Medicine section

• 90587 Dengue vaccine, quadrivalent, live, 3

dose schedule, for subcutaneous use

• 90750 Zoster (shingles) vaccine (HZV), live for

subcutaneous injection


63

Pulmonary medicine

New code

• 94617 Exercise test for bronchospasm,

including pre- and post- spirometry,

electrocardiographic recording(s), and pulse

oximetry

• Includes a pulmonary tests and

electrocardiographic recordings


64

Pulmonary medicine

New code

• 94618 Pulmonary stress testing (e.g., 6-minute

walk test), including measurement of heart rate,

oximetry, and oxygen titration, when performed

• Includes measurements of heart rate and

oxygen levels (oximetry and oxygen titration),

when performed

• 94620 deleted


65

Pulmonary medicine

Revised

• 94621 Cardiopulmonary exercise testing,

including measurements of minute ventilation,

CO2 production, O2 uptake, and

electrocardiographic recording

• Do not report with EKG, rhythm ECG, stress

testing, and some pulmonary function tests


66

Endocrinology

Revised

• 95250 Ambulatory continuous glucose

monitoring of interstitial tissue fluid via a

subcutaneous sensor for a minimum of 72

hours; physician or other qualified health care

professional (office) provided equipment, sensor

placement, hook-up, calibration of monitor,

patient training, removal of sensor, and printout

of recording

• Physician owns equipment


67

Endocrinology

New Code

• 95249 Ambulatory continuous glucose monitoring of

interstitial tissue fluid via a subcutaneous sensor for a

minimum of 72 hours; patient-provided equipment,

sensor placement, hook- up, calibration of monitor,

patient training, and printout of recording

• Equipment not owned by physician

Revised

• 95251 Analysis, interpretation and report

• Do not report 95251 more than once/month


68

Neurology

Revised

• 95930 Visual evoked potential (VEP) checkerboard or

flash testing, central nervous system except glaucoma,

with interpretation and report

• 96567 Photodynamic therapy by external application of

light to destroy premalignant lesions of the skin and

adjacent mucosa with application and

illumination/activation of photosensitive drug(s), per day


69

Photodynamic therapy

New codes

• 96573 Photodynamic therapy by external application of light

to destroy premalignant lesions of the skin and adjacent

mucosa with application and illumination/activation of

photosensitizing drug(s) provided by a physician or other

qualified health care professional, per day

• 96574 Debridement of premalignant hyperkeratotic lesion(s)

(i.e., targeted curettage, abrasion) followed with

photodynamic therapy by external application of light to

destroy premalignant lesions of the skin and adjacent

mucosa with application and illumination/activation of

photosensitizing drug(s) provided by a physician or other

qualified health care professional, per day


70

Therapeutic intervention

New code

• 97127 Therapeutic interventions that focus on cognitive

function (e.g., attention, memory, reasoning, executive

function, problem solving, and/or pragmatic functioning)

and compensatory strategies to manage the

performance of an activity (e.g., managing time or

schedules, initiating, organizing and sequencing tasks),

direct (one on one) patient contact

• Report only once per day


71

Cognitive skills

Deleted

• 97532 Development of cognitive skills to

improve attention, memory, problem solving

(includes compensatory training), direct (one on

one) patient contact, each 15 minutes

• Use 97127


72

Orthotics

Revised

• 97760 Orthotic(s) management and training

(including assessment and fitting when not

otherwise reported), upper extremity(ies), lower

extremity(ies) and/or trunk, initial orthotic(s)

encounter, each 15 minutes

• 97761 Prosthetic(s) training, upper and/or lower

extremity(ies), initial prosthetic(s) encounter,

each 15 minutes


73

Orthotics

New Code

• 97763 Orthotic(s)/prosthetic(s) management

and/or training, upper extremity(ies), lower

extremity(ies), and/or trunk, subsequent

orthotic(s)/prosthetic(s) encounter, each 15

minutes

• Do not report 97763 with 97760, 97761


74

CPT change in 2018

• Start with Appendix B in your CPT book

• Buy the Professional Edition from AMA

• If changes in your specialty, buy: CPT 2018

Changes An Insider’s View


75

Thank you

Betsy Nicoletti

www.betsynicoletti.com

www.codingintel.com

[email protected]

Follow me on twitter

@BetsyNicoletti


76

CEU Reminder:

Attendees of the live webinar will receive

a follow-up email by December 8th with

the webinar recording, handouts and

webinar CEU certificate.

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