AMA Releases 2019 Coding Changes

The American Medical Association (AMA) has released the 2019 Current Procedural Terminology (CPT^®) code set. The code set for the coming year includes 335 code updates as well as significant changes to certain descriptors.

According to the announcement from the AMA, the changes for 2019 reflect the “tremendous potential of using connected health tools to better support clinicians in patient population health and care coordination services, and other novel delivery systems that are vital for improving the overall quality of health care,” and are intended to “reflect how health care professionals can more effectively and efficiently use technology to connect with their patients at home and gather data for care management and coordination.”

The following are key changes included in the 2019 code set which is currently scheduled to go into effect January 1.

·         Six new Evaluation and Management (E&M) codes.

·         Guidelines revised for Interprofessional Telephone/Internet/Electronic Health Record Consultations.

·         New codes 99451 and 99152 added to report assessment and management services, based on medical consultative time.

·         New CPT codes 99453 and 99454 added to report remote physiologic monitoring services during a 30-day period.

·         Other codes in this section (99446-99449 and 99091) also revised.

·         New CPT code 99457 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.

·         Fine needle aspiration (FNA) codes received new instructional notes including the definition of a fine needle aspiration and a core needle biopsy.

·         Imaging guidance added to nine new codes and reporting imaging guidance separately is no longer reportable.

·         Guidelines direct that the codes are selected based in guidance (included) and add on-codes for each additional lesion, same imaging modality.

o    When using different imaging modalities when more than one lesion is involved, Modifier 59 is appended.

o    CPT code 10021 (FNA) without imaging guidance is reported.

·         CPT code 10022 was deleted and replaced with CPT 10004 for each additional lesion.

·         CPT codes 10005-10012 were added to report the specific imaging guidance (ultrasound, fluoroscopic guidance, CT and MRI).

·         CPT codes 11100 and 11101 for skin biopsies were deleted.

·         New guidelines for coding biopsies.

·         Six new codes (11102-11107) for skin biopsies based on method of removal including tangential (shave, scoop, saucerize, curette), punch and incisional.

·         CPT codes 20932-20934 added for allografts.

o    CPT 20932 includes templating, cutting, placement and internal fixation; osteoarticular.

o    CPT 20933 is hemicortical, intercalary, partial.

o    CPT 20934 is hemicortical, complete.

·         CPT 27369 added to report an injection procedure for contrast knee arthrography or contrast enhanced CT/MRI knee arthrography.

·         CPT code 27370 was deleted likely due to being reported incorrectly as arthrocentesis or aspiration.

·         New CPT codes 33274 and 33274 are used for reporting a transcatheter insertion or replacement and removal of a permanent leadless pacemaker, right ventricle.

·         Codes 33285 and 33286 have been created for the insertion and removal of a subcutaneous cardiac rhythm monitor.

·         CPT 33289 is for a transcatheter implantation of a wireless pulmonary artery pressure sensor.

·         New CPT code 93264 is used to report remote monitoring of a wireless pulmonary artery pressure sensor for up to 30 days.

·         CPT 33440 was added for the replacement of the aortic valve by translocation.

·         CPT code 33866 created for an aortic hemiarch graft.

·         New CPT codes 36572 and 36573 are used for an insertion of a peripherally inserted central venous catheter (PICC) without a subcutaneous port or pump, based on age.

·         New CPT code 38531 is used to report a biopsy or excision of an open inguinofemoral lymph node.

·         Changes were made to the gastrostomy tube placement codes.

o    CPT code 43760 was deleted.

o    New CPT code 43762 is reported for the percutaneous gastrostomy tube placement including removal without imaging or endoscopic guidance not requiring revision of the gastrostomy tract.

o    CPT 43763 requires revision of gastrostomy tract.

·         CPT codes 50436 and 50437 are used to report dilation of existing tract, percutaneous for an endourologic procedure including imaging guidance with post procedural tube placement.

·         CPT 50437 is reported when new access into the renal collecting system is performed.

·         New CPT code 53854 was added to report a transurethral destruction of prostate tissue by radiofrequency generated water vapor thermotherapy.

·         New codes were established for ultrasound elastography, CPT 76981-76983 to distinguish reporting, per organ, first target lesion and each additional target lesion.

·         New CPT code 76391 is used to report Magnetic resonance (vibration) elastography.

·         Two new CPT codes 76978-76979 are used to report ultrasound procedures that use dynamic microbubble-sonographic contrast with targeted ultrasound to evaluation lesions.

·         Four new breast MRI procedures were added (77046-77049), based on laterality (unilateral vs. bilateral) and with or without contrast material.

·         CPT codes 77058 and 77059 were deleted.

·         CPT code 90689 was added to report an inactivated adjuvanted preservative free flu vaccination.

·         New CPT codes 92273 and 92274 were added in the Ophthalmology section to evaluate function of the retina and optic nerve of the eye.

o    CPT 92273 was added to report global response of photoreceptors of the retina.

o    CPT 92274 to report photoreceptors in multiple separate locations in the retina and macula.

•  CPT code 95836 (electrocorticogram) was added to report recording of EC_oG 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.

·         New guidelines and new CPT codes were added to the Central Nervous System Assessments/Tests including 96112 and 91113 for developmental test administration based on time.

·         CPT 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.

·         CPT codes 96136-96139 were added to report psychological or neuropsychological report testing and scoring, based on time and whether the service was performed by a technician or clinician.

o    CPT code 96146 is used to report psychological or neuropsychological automated testing using an electronic platform.

·         New codes for programming a neurostimulator were added with CPT odes 95976-95984. Codes, based on the nerve selected and simple versus complex.

·         Eight new CPT codes 97151-97158 and guidelines were added to Adaptive Behavioral services to address deficient adaptive behaviors.

·         Several pathology and laboratory codes and category III codes.

In the release, AMA President Barbara L. McAneny, MD, said the code set “is the foundation upon which every element of the medical community—doctors, hospitals, allied health professionals, laboratories and payers—can efficiently share accurate information about medical services”. McAneny added, “The latest annual changes to the CPT code set reflect new technological and scientific advancements available to mainstream clinical practice, and ensure the code set can fulfill its trusted role as the health system’s common language for reporting contemporary medical procedures. That’s why we believe CPT serves both as the language of medicine today and the code to its future.”