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Medical Coding News Archives

CPT Code Changes Include New Modifiers, Chest X-ray Codes

 
October 31, 2017:

The CPT code changes for 2018 particularly affect radiology codes for chest x-rays and cardiology, anesthesia, evaluation and management (E/M), laboratory, and category III codes. There are also two new physical, occupational, and speech therapy modifiers for 2018, one for habilitative services and one for rehabilitative services.

Chest x-rays: The American Medical Association, which created and maintains the CPT codes, has simplified the coding of chest x-rays by reducing the number of code choices from nine to just four. Codes 71010, 71015, 71020-71023, 71030, 71034, and 71035, which described x-rays as “stereo,” “with apical lordotic procedure,” “with fluoroscopy,” or “special views,” have been deleted for 2018. Now, the coder merely has to know whether the x-ray was taken with one, two, three, or four views (new codes 71045-71048), greatly easing code selection.

Cardiology: In addition to three new codes describing implantation and removal of artificial hearts, the AMA added extensive guidelines and created 16 codes under “Endovascular Repair of Abdominal Aorta and/or Iliac Arteries.” Six of the codes (34701-34706) describe the introduction, positioning, and deployment of endografts to treat conditions affecting the abdominal aorta. Codes 34707 and 34708 describe endovascular repair of the iliac artery, and 34709-34711 the placement of an extension prosthesis terminating in the internal or external iliac, or common femoral artery or the abdominal artery proximal to the renal artery. It should be noted that the delayed placement of distal or proximal extension prosthesis (34710-34711) should not be reported in addition to 34701-34709. Code 34712 has been added for transcatheter delivery of enhanced fixation devices to an endograft and may be reported only once per operative session. Code 34713 was created to report the unilateral percutaneous access and closure of the femoral artery so as to deliver an endograft through a sheath. This code may be reported only once per side, however; when the procedure is performed bilaterally, report 34713 twice or with modifier 50 (Bilateral procedure). Code 34714 describes the exposure of the femoral artery and creation of a conduit for an endovascular prosthesis or for cardiopulmonary bypass. Code 34714 also may be reported only once per side or, when performed bilaterally, twice or with modifier 50. Finally, new codes 34715 and 34716 are used to report the exposure of the axillary or subclavian artery to deliver an endovascular prosthesis and the creation of a conduit to deliver an endovascular prosthesis or for cardiopulmonary bypass.

There are two new codes under “Vascular Injection Procedure”: 36465 and 36466. These codes describe the injection of foam sclerosant using ultrasound compression to guide dispersal of the injection in incompetent extremity truncal veins.

Anesthesia: For the first time in a few years, the AMA has created new anesthesia codes. Code 00740, which described anesthesia for procedures to the upper gastrointestinal system using an endoscope introduced proximal to the duodenum, has been deleted and replaced by two new codes, 00731 and 00732. The first code has the same description as 00740 except with “not otherwise specified” added, and code 00732 specifies endoscopic retrograde cholangiopancreatography (ERCP).

Code 00810, which describes procedures to the lower intestine using an endoscope introduced distal to the duodenum, has also been deleted for 2018. In its place are new codes 00811, 00812, and 00813. Similar to the change above, the description for code 00811 is identical to that of 00810 except for the addition of “not otherwise specified,” and code 00812 adds greater specificity, in this case screening colonoscopy. A note instructs the coder to use 00812 to report anesthesia regardless of the colonoscopy findings. New code 00813 describes anesthesia for procedures on the upper and lower gastrointestinal system using an endoscope introduced both distal and proximal to the duodenum.

Codes 01180 and 01190, which describe extrapelvic and intrapelvic anesthesia for obturator neurectomy, have been deleted for 2018.

E/M: In this section, the AMA added “outpatient hospital” before “observation status” in the code explications for 99217-99220 and deleted codes 99363 and 99364, which described supervision of warfarin therapy. A new section, “Cognitive Assessment and Care Plan Services,” has been added, along with new code 99483, which is used to report a comprehensive assessment of and care planning for a new or existing patient with impaired cognition. The code explication notes that such an assessment typically takes close to an hour of face-to-face time with the patient or caregiver. A physician or other qualified healthcare professional cannot report this code for the same patient more frequently than once every 180 days.

Also new for 2018 is the section “Psychiatric Collaborative Care Management Services,” with new codes 99492, 99493, and 99494 describing initial and subsequent psychiatric collaborative care management. These services encompass care provided by the treating physician or other qualified healthcare professional, as well as the behavioral health care manager and psychiatric consultant who has contracted with the physician to provide consultation services.

A new code has also been added under the new section “General Behavioral Health Integration Care Management.” Code 99484 describes at least 20 minutes of clinician time spent per month managing care for behavioral conditions. A physician or other qualified healthcare professional must direct the care. Note that time spent coordinating care while the patient is an inpatient or under observation may not be reported with this code, but time spent coordinating care with the emergency department can be.

Laboratory: The presumptive drug testing codes (80305-83037) have revisions this year that should ease determining correct code assignment based upon the type of methodology used to perform the service. Once again a number of Molecular Pathology codes were either revised or added for 2018 to describe molecular testing that helps clinicians develop the best treatment course.

Category III: As usual, many new technology codes were added in this section. Of note are codes 0483T and 0484T (percutaneous and transthoracic implantation or replacement of a transcatheter mitral valve with a prosthetic valve), which are accompanied by extensive guidelines. The AMA notes that both codes include several of the procedures performed and services provided in conjunction with the implantation or replacement, such as balloon valvuloplasty, the temporary insertion of a pacemaker, angiography, and radiological supervision and interpretation. Codes for diagnostic catheterization of the right and left heart can be reported separately if no full study was performed previously or if it was, the anatomy or pathology was not visualized adequately, the patient’s condition has changed, or a clinical change during the TMVI warrants a new study.

New modifiers: New modifiers 96 (Habilitative Services) and 97 (Rehabilitative Services) will most likely be used by occupational and speech therapists more than physical therapists. The first can be added to a medicine code for a service that could be either habilitative or rehabilitative to distinguish it as habilitative. Such services help patients learn daily living skills they have never had and help them keep or improve these new skills. For instance, modifier 96 could be appended to code 97535 (self-care training) if it is used to report teaching a patient how to groom himself because he never had these skills due to an intellectual disability (habilitative). Modifier 97 is added to codes to denote them as rehabilitative; these services help patients relearn, keep, or improve daily living skills they lost or had impaired because of illness, injury, or disability. For example, this modifier could be added to code 97116 (gait training) ) if a patient who has suffered head trauma is taught to climb stairs again (rehabilitative).

CPT © 2017 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

 

 
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