Hello Readers!

During our last meeting with our back end team, one of the topic which they brought to our attention is about the changes in CPT 2020 which is very important for all the Medical Coders across the United States of America to know about.  We have researched on it and compiled our findings where it will help a lot of practices, providers, medical coders and billing companies.

All sections of the CPT received changes in codes and there are no changes in Anesthesia coding guidelines.  Gist on the overall changes in CPT includes,

  • 314 newly added codes
  • 76 revised codes
  • 97 deleted codes.

 

The most significant changes are to codes for fat grafting, insertion of drug delivery during orthopedic procedures, nasal endoscopy, molecular pathology, and Electro encephalogram (EEG) monitoring services.

Since the changes are more, this blog elaborates changes on Evaluation and Management, Surgery and Musculoskeletal and the rest of the areas will be covered in the coming weeks.

 

EVALUATION AND MANAGEMENT (E/M)

Online digital E/M services

 

Though the coding of online E/M services is not new, the codes and the description has been defined more clearly and is aligned with the times in the telephone care service codes.

  • Three new codes (99421-99423) and new guidelines have been established for reporting online digital evaluation and management (E/M) services (e-visits).

You’ll choose among the codes based on the time involved:

  • 99421 – Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
  • 99422 – 11-20 minutes
  • 99423 – 21 or more minutes
  • Code 99444 (online E/M service) will be deleted.

 

Remote Physiologic Monitoring

The code for remote physiologic monitoring treatment management services (99457) is revised to be time – based, requiring 20 minutes.

  • 99458 – A new add-on code has been established to report each additional 20 minutes of remote physiologic monitoring treatment management services.

 

Two new codes (99473 and 99474) have been added for reporting self-measured home blood pressure monitoring using a validated device.

  • 99473 Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration
  • 99474 separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient
  • 99499 for online evaluation and management services was deleted.

Online Digital E/M services provided by a Qualified Nonphysician Healthcare Professional 

  • The CPT 2020 code set will also include three new codes (98970-98972) that are almost identical to 99421-99423.
    • The difference is that the descriptors for 98970-98972 state that a “Qualified nonphysician health care professional” performs the service.
    • Because QHPs may use E/M codes 99421-99423, practices may wonder when it is appropriate to use 98970-98972 for a “qualified nonphysician.” Instructions for 99421-99423 on the CPT book will be helpful to point you to 98970-98972 for professionals “who may not report the physician or other qualified health care professional E/M services”
    • Examples: speech-language pathologists, physical therapists, occupational therapists, social workers, dietitians

 

 

SURGERY:

Integumentary section

New guidelines and five new grafting codes (15769, 15771-15774) have been added in the Dermatology subsection for reporting grafting of autologous soft tissue harvested by excision or autologous fat harvested by liposuction.

  • 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.
  • Code 15771 and add code 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
    • Add on 15772 is an add-on code for each additional 50 ccs or part thereof.
  • Code 15773 and add on code 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
    • Add on code 15774 is an add-on code for each additional 25 ccs or part thereof.

The guideline 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 repair includes 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 repair includes extensive undermining, which CPT describes as “a distance greater than 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. Parenthetical notes are added to direct you to the correct codes for this service.

  • Code 19304 is deleted due to low utilization.

Codes for the excision for chest wall tumors are deleted and replaced with new codes in the Musculoskeletal System section.

  • New CPT Code 21601, 21602, and 21603 are added in Musculoskeletal System
  • Codes 19260, 19271 and 19272 are deleted

 

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
  • Code 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.