Valerie Sisson, CPC, RCC, Lead Certified Coder for Comprehensive Medical Solutions, Inc. (CompMed) and Sarah Reed, CPC, certified coder at CompMed, have reviewed the CPT and Diagnosis code changes for 2019. Sisson said, “There is not a significant volume of changes for 2019 like we have seen in the past. Practitioners involved with PICC lines and Fine Needle Aspirations should note major changes regarding those services.”
Below are the CPT and Diagnosis code changes affecting several practice types:
For 2019 there is a slight increase in the national anesthesia Conversion Factor from $22.1887 to $22.2986.
Below are several examples of 2019 Conversion Factors for the specific states:
Atlanta Georgia $22.30 $22.38
Rest of Georgia $21.94 $22.02
Mississippi $20.89 $20.96
Tennessee $21.20 $21.28
Base Units did not change for Calendar Year 2019.
The Center for Medicare and Medicaid Services (CMS) is proposing changes to documentation requirements for Evaluation and Management (E&M) CPT codes. Changes include:
- Options to allow providers to document E&M Services based on time;
- Eliminating the policy preventing payment for same day E&M visits by multiple practitioners in the same specialty;
- Medical decision making, time, or choosing either the 1995 or 1997 E&M documentation guidelines.
- CMS is proposing practitioners focus on what has changed since the patient’s last visit as opposed to items that have not changed.
In November 2018 , CMS launched their new online tool to help consumers compare Medicare payments and copayments for services or procedures that are performed in both hospital outpatient departments and ambulatory surgical centers. The Procedure Price Lookup tool3 provides national averages for the amount Medicare pays the hospital or ambulatory surgical center and the national average copayment amount a beneficiary with no Medicare supplemental insurance would pay the service provider.
Seema Verma, Administrator of CMS, says, “Price transparency in health care is a priority for the Trump Administration. Working with their clinicians, the Procedure Price Lookup will help patients with Medicare consider potential cost differences when choosing where to have a medical procedure that best meets their needs.”
The Procedure Price Lookup tool is required by 21st Century Cures Act.
- Eligible Clinicians (EC) need to meet one of the following three criteria to be excluded from MIPS: have less than $90,000 Medicare Part B allowed charges for covered professional services OR provide services to more than 200 Medicare beneficiaries OR provide more than 200 covered professional services under the Medicare Physician Fee Schedule (MPFS);
- CMS has proposed that out of the 100 points available, 45% will be allocated to Quality Measures, 25% will be allocated to Promoting Interoperability, 15% will be allocated to Improvement Activities, and 15% will be allocated to Cost;
- The proposed performance threshold for 2019 is 30 MIPS Total Points. Groups or ECs who fail to participate or fail to meet the 30 point threshold may incur up to a negative 7% payment adjustment in 2021.
Anticipate a revision to the fine needle aspiration code 10021, deletion of 10022, and the addition of nine new codes that bundle the procedure and the radiological supervision and interpretation (S&I) code.
Fine needle aspiration (FNA) code 10022 will be referred to the Current Procedural Terminology (CPT) Panel for bundling with 76942.
Breast MRI (Magnetic Resonance Imaging) with CAD (Computer Aided Detection) – CPT Codes 77058, 77059 and 0159T are proposed to be deleted and replaced with four new breast magnetic resonance imaging codes: two codes to report breast MRI with and without contrast, and two codes that bundle CAD. The new codes will convert breast MRI with CAD from Category III to Category I codes.
Knee Arthrography – Injection of contrast for knee arthrography, code 27370, was identified as a potentially mis-valued service. This is likely due to it being reported incorrectly as arthrocentesis or aspiration. It has beenrecommended that code 27370 be referred for deletion and be replaced with a new code to report the injection procedure.
Ultrasound Elastography (USE) – Three new Category I codes will be established for ultrasound elastography, the new codes will distinguish reporting per organ, first target lesion, and each additional target lesion. Category III code 0346T is proposed for deletion.
Magnetic Resonance Elastography (MRE) – Magnetic resonance elastography (MRE) is a new diagnostic imaging technology; currently there is no CPT code available to describe this procedure; a new CPT code is being proposed.
Contrast Enhanced-Ultrasound (CEUS) – Look for two new codes to report ultrasound procedures that use dynamic microbubble-sonographic contrast with targeted ultrasound to evaluate lesions.
Fluoroscopy – Fluoroscopy CPT code 76001 will likely be deleted due to low volume reporting as this service is rarely performed.
Peripherally Inserted Central Catheter (PICC) – The PICC line codes have been referred to bundle imaging. Two new codes will be available that describe PICC line procedures that bundle imaging guidance, image documentation and all associated radiological S&I. The description will be updated to assure that codes 36568 and 36569 are used to report PICC placement without imaging guidance, and code 36584 will be revised to include imaging guidance, image documentation, and radiological S&I to perform the replacement. The central venous access procedures guidelines in the CPT codebook will also be updated to reflect these changes.
Gastrostomy Tube Replacement – Several different specialties and providers report code 43760. To address the differences in provider work, code 43760 will be deleted and replaced with two new codes that define simple versus complex replacement of a percutaneous gastrostomy tube.
Dilation of Urinary Tract – Two new codes will likely be created to report dilation of the urinary tract for endourologic procedures; code 50395 will be deleted. Guidelines on how to report the new codes will be included in the urinary system section of the CPT codebook.
Following are new ICD10 (International Classification of Diseases) codes added for acute appendicitis:
K35.20 – w/ generalized peritonitis, w/o abscess
K35.21 – w/ generalized peritonitis, with abscess
K35.30 – w/ localized peritonitis, no perforation(rupture) or gangrene
K35.31 – w/ localized peritonitis, w/ gangrene, but no perforation
K35.32 – w/ localized peritonitis, w/ perforation, but no abscess
K35.33 – w/ localized peritonitis, w/ perforation and abscess
K35.890 – other acute appendicitis, w/o perforation or gangrene
K35.891 – other acute appendicitis, w/o perforation, with gangrene
These are new ICD10 codes for Renal Abscess:
K61.31 Horseshoe abscess
K61.39 Other ischiorectal abscess
K61.5 Supralevator abscess
New ICD10 codes for Gallbladder/Biliary Tract Disorder:
K83.01 – Cholangitis ( Primary sclerosing): revised from K83.0
K83.09 – Cholangitis ,other
K81.9 – Cholecystitis NO CHANGE
K82.A1 – Cholecystitis w/ gangrene
K82.A2 – Cholecystitis w/ perforation of gallbladder
PATIENT RELATIONSHIP CATEGORIES7
- Continuous/Broad Services – For reporting services by clinicians who provide the Principal care for a patient, with no planned endpoint of the relationship. Services in this category represent Comprehensive care, dealing with the entire scope of patient problems, directly or in a care coordination role. Examples would be primary care services and specialists providing comprehensive care to patients in addition to specialty services.
- Continuous/Focused Services – For reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or condition that needs to be managed and followed for a long time. Example would be a rheumatologist taking care of the patient’s rheumatoid arthritis longitudinally, but not providing general primary care services.
- Episodic/Broad Services – For reporting services by clinicians who have broad responsibility for the comprehensive needs of the patients, that is limited to a defined period and circumstance, such as hospitalization. Example would be hospitalist providing comprehensive and general care to a patient while the patient is in hospital.
- Episodic/Focused Services – For reporting services by specialty focused clinicians who provide time-limited care. The patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention. Example would be an orthopedic surgeon performing a knee replacement and seeing the patient through post-op period.
- Only as ordered by another Clinician – For reporting services by a clinician who furnishes care to the patient only as ordered by another clinician. This patient relationship category is reported for patient relationships that may not be adequately captured in the other four categories. Example would be a radiologist interpretation of an imaging study ordered by another clinician.