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Category 3 code changed: Know the revised CPT codes for the New Year.

The Current Procedural Terminology or CPT is a trademark of the American Medical Association (AMA). CPT is divided into three sets of codes. Category 3 is a temporary set of codes used for emerging technologies, services, procedures, and service paradigms in the coding and billing system.

The five character CPT codes are used by the medical professionals while reporting and documenting various medical, surgical, radiology, laboratory, and evaluation and management (E/M) service. The American Medical Association (AMA) has released 335 CPT Code Changes first time in between a current year in September of 2018. These mid-year releases will be effective from January of 2019 according to the Category III Code Semi-Annual Early Release Schedule.

In the 2018 CPT editorial panel meeting, significant CPT Code Changes have been made in the system. After reviewing, it has been noticed that the complete revision of the codes has been done keeping the latest technology in mind. The changes have a visible impact of the most recent advances in the surgical, diagnostic as well as medical services.  

According to AMA President Barbara L. McAneny, M.D,

"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."

Among the many changes made by AMA, here are few of the 335 code changes that you couldn’t afford to miss to precede your medical coding and billing practice in the next couple of years.

 1.     Evaluation and Management code changes

 There are six new codes added and four old codes revised in the E/M CPT codes.

a) New codes 99451 and 99452 are introduced for consultative time basis in Medicare. These codes are added to report assessment and management services.

b) New CPT codes 99453 and 99454 are added to be reported for remote psychological monitoring services during a 30-day period.

c) Code 99457 is also a new code beneficial for efficient communication between the patient and the caregiver.

d) Various other codes 99091, 99446, 99447, 99448 and 99449 have been revised for the year 2019.

2.     Integumentary System

a) In 2019, to report Fine Needle Aspiration, CPT has added a single code for reporting by instructing new notes by giving the definition of FNA too.

b) For each additional lesion, CPT code 10004 has been added and replaced the code 10022.

c) To report specific image guidance such as ultrasound, fluoroscopic guidance, CT and MRI, codes 10005-10012 have also been added.

d) For skin biopsy techniques, new codes 11102-11107 have been added to the integumentary system of 2019. Also, codes 11100 and 11101 have been deleted from a skin biopsy.

3.     Imaging-Radiology

a) New CPT codes 76981-76983 have been added to report ultrasound elastography.

b) New codes from 77046-77049 are also a new addition to the CPT codes. These new codes are made to report breast MRI procedures with or without contrast material which can be unilateral and bilateral.

c) Codes 78270-78272 are designated to be deleted from the new 2019 codes.

4.     Medicine section

a) CPT codes 96136-96139 have been added to the coding system to report psychological and neurological testing and scoring by physicians/technicians respectively.

b) For interpreting and reporting Electroretinography (ERG), Ophthalmology section ahs add two new codes 92273 and 92274. This is important to assess the function of the retina and optic nerve of the eye.

c) Codes 97151-97158 have been added in the new 2019 CPT codes to evaluate deficient adaptive behavior. These codes will help with the guidelines related to adaptive behavioral services.

5.      Changes in the cardiovascular system

a) To report the insertion and removal of permanent leadless peacemaker, new codes have been addressed in the cardiovascular system.

b) CPT codes 33285 and 33286 have also been to report removal and insertion of subcutaneous cardio rhythm monitor.

c) To describe the procedure of aortic valve replacement, code 33440 has also been added to the system.

6.     Other miscellaneous changes

a) To report open biopsy or excision of lymph nodes, CPT code 38531 has been introduced in the Hemic and Lymphatic system.

b) Code 66220 is designated to be deleted from the ocular eye section.

c) Two new codes, 50436 and 50437 have replaced the deleted 50395 to report the renal collecting system in an endourologic procedure.

d) Code 50395 is designated to be deleted in 2019 related to the introduction of the guide into the renal pelvis and/or ureter system.

These are few of the numerous CPT codes changes designated for 2019. These code changes are imperative for your medical coding and billing performance which will help you move your career forward with the changes in the codes.

Join SymposiumGo and update your career with all the annual or mid-year changes in the medical structure.    

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Final Rule on E/M Services - What CMS Changes Mean for your practice?

On July 27, 2018, the Centers for Medicare & Medicaid Services (CMS) released a proposed Rule ‘CMS-1693-P’ with an aim to lower the cost of American Healthcare System. The reformed guidelines modified the documentation timing by using the latest Current Procedural Terminology (CPT) code requirements by the American Medical Association (AMA).

The most imperative refurbishments have been made to the Evaluation and Management (E&M) services as well as telemedicine reimbursement.

Evaluation and management services are used by various healthcare providers for medical coding in support of medical billing. In the healthcare industry, reimbursement by Medicare, Medicaid programs, or private insurance for patient encounters is done by using these guidelines only.

CMS is proposing various changes in the coding and billing process of E/M Guidelines. In the healthcare industry, these guidelines have not been updated since the last 20 years. But preceding July, CMS proposed a dramatic overhaul in the system.

The reformation done will make the payment system in the industry more transparent with an undertaking to make it easier for patients as well as physicians. The recommended implementations by CMS will chiefly update Medical Decision-Making (MDM), Physician Fee Schedule (PFS) and calendar-year 2019 Quality Payment Program (QPP).

Although a two-year window has been given for 2019-20, the proposed final rule has already started to reduce the burden of patients as well as the physician. The aim is to replace the existing 5 tier system into one single uncomplicated payment system and to lower the complex documentation procedure.

Pre-CMS Overhaul And The Reasons Behind The Proposed Refurbishment

For more than two decades, physicians have struggled with unnecessary paperwork and overcomplicated regulatory requirements. With each patient visit, the Evaluation and management documentation process had become a burdensome process for the billers and coders. The necessity of a change in the recording of E/M visits was simmering for a long time in the healthcare industry.

Multiple visits of patients in a day were re-documented which created redundant paperwork and deviated decision-making process of medical practitioners. It was hard for physicians to focus on the patient and give them the proper time they needed.

The Quality Payment Program (QPP) has also faced excessive regulations with minimal technology-based service evaluation. High-Quality patient care was much needed in the virtual care of the patient. Restructuring both Merit-based Incentive Payment System (MIPS) and Average Sales Price (ASP) was required to reduce provider reimbursement rates for new drugs under Medicare.

Post CMS Overhaul

On November 1st of 2018, CMS published the final rule reforming important guidelines followed during EM visits. The 2379 pages overhaul has taken a giant leap forward in the following topics:-

1.    Virtual Care

CMS has made a colossal change in the method of “check-ins” with doctors. With the introduction of virtual care, they have made the interaction between doctors and patients less time-taking. The new rule will provide technology-based communication services in exchange of classified videos/images. This will save patients the time to travel and visits doctors’ office. CMS is taking the services to next level by proposing telemedicine services with online payments and communication.  

2.    1995 &1997 Documentation

A long-awaited change also took place in the previous year’s final rule. The Medicare billing of the E/M office and outpatient visits either uses the 1995 or 1997 E/M guidelines documentation. But after the overhaul, regardless of the level of history, physicians could choose the documentation of an E/M visit by time or their decision making authority.  

3.    Single Payment Rate And System

After the refurbishment, CMS has reduced the payment variation by proposing a single payment rate system. The proposed method includes both new patients’ visits (99202-99205) as well as established patients’ visit (99212-99215). The decision affirms one rate for payment of level one patients and a different payment rate for level 2-5.

The documentation requirements for level 2 will cover the documentation for all the levels from 2 through 5. Unless the time factor is used to document the services, the documentation requirements (history, examination, and medical decision-making) will be the same.

4.    Reduction In Redundant Work

From 2021, the rule of two separate billing of E/M visits of a minor procedure scheduled at the same day will be eliminated. E/M payment will be reduced by 50% of the least expensive procedure. This will reduce the revenue of the practitioners but will benefit patients. CMS is proposing telemedicine services with online payments and communication to alleviate the burden of patients.

5.    Introduction of Add-on codes

In office and outpatient E/M levels 2-4 where a patient requires complex care, the rule has introduced add-on HCPCS Level II codes. This will eliminate the new per visit document requirements in providers’ reimbursement. For complex care patients, a new add-on G code will be billed with the primary code to adjust the additional costs used in level 2-5.

For primary care, the add-on amount would be $5, and for approved specialties above the E&M level 2-5, $14 would be accepted.

These E/M changes are going to impact the healthcare industry at large. And to help you update your practice with these changes, our healthcare webinar will assist you in becoming versed in all the upcoming revisions. SymposiumGo will provide you with numerous essential webinars which will aid you to achieve the next level in your practice.

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