The New Year’s Impact on CPT Codes

December 2019 | Article

By Susan Rohde

The new year will usher in more than just a new decade. In addition to year-end planning, health care entities need to pay attention to a number of changes impacting CPT codes, the code set used to report medical, surgical and diagnostic procedures.

What Changes Are Impacting CPT Codes?
Starting January 1, 2020, there will be 394 total code changes. This includes 248 new codes, 71 deletions and 75 revisions to the current CPT code set. Several of these code additions and deletions will have an immediate impact.

CPT Codes within the E/M Section
While there are a number of new changes coming in 2021 to the Evaluation and Management (E/M) section, several code additions and deletions will have immediate impact.

As a reminder CPT uses the following symbols:
● New CPT code
▲ Revised CPT code
# Resequenced CPT code
+ Designated add-on CPT code

Online digital E/M services
Our constantly changing digital world is continuing to impact healthcare and medical coding, especially how healthcare entities communicate with clients. Three new time-based codes were created to better define previous codes and promote the usage of patient portals.
#●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.

Please note that codes 99421, 99422 and 99423 describe patient-initiated digital communications with a physician or other qualified health professional while codes 98970, 98971 and 98972 represent patient-initiated digital communications with a nonphysician health professional.

The reason for these changes is summed up by American Medical Association president Patrice Harris. “With the advance of new technologies for e-visits and health monitoring, many patients are realizing the best access point for physician care is once again their home,” said Harris. “The new CPT codes will promote the integration of these home-based services that can be a significant part of a digital solution for expanding access to healthcare, preventing and managing chronic disease and overcoming geographic and socioeconomic barriers to care.”

However, several caveats apply to the above-mentioned codes, per CMS:

  • Patient must be established, while the problem being addressed may be new to provider.
  • Patient must initiate the service through Health Insurance Portability and Accountability Act (HIPAA)-compliant secure platforms, such as electronic health record portals, secure email or other digital applications.
  • Codes can be reported once per seven-day period.
  • Time begins with the initial personal review of the patient-generated inquiry.
  • Time counted is spent in evaluation, professional decision-making, assessment and subsequent management.
  • Time is accumulated over the seven days and includes time spent by the original physician and any other physicians or other qualified health professionals (QHPs) in the same group practice who may contribute to the cumulative service time of the patient’s online digital E/M service.
  • Time does not include time spent on nonevaluative electronic communications including but not limited to scheduling appointments, referral notifications and test result notifications.
  • Permanent documentation storage (electronic or hard copy) of the encounter(s) is required.
  • If a separately reported E/M visit occurs within seven days of the initiation of an online digital E/M service, then the physician or other QHP work devoted to the online digital E/M service is incorporated into the separately reported E/M visit.
  • Do not report this service during a procedural global period.

Another change in relation to online digital tools comes in the form of two new codes. Code 99473 (self-measured blood pressure using a device validated for clinical accuracy) and Code 99474 (including separate self-measurements of two readings, one minute apart) were created to allow patients to report self-measured blood pressure monitoring/readings. These codes will allow physicians to better diagnose and treat conditions such as hypertension.

Other Changes to CPT Codes
Acupuncture
Dry needling and trigger point acupuncture will have two new codes for needle insertion without injection:
●20560 Needle insertion without injection; 1 or 2 muscles
●20561 3 or more muscles.

These codes identify services that are not “injections” since there is no injectable substance. These particular CPT codes are not to be assigned for acupuncture because all elements required for acupuncture are not completed for these procedures.

Manual Preparation and Implants
New add-on codes 20700-20705 describe manual preparation and insertion of implants designed to deliver drugs, such as antibiotics, to deep musculoskeletal spaces. The implants may take the form of beads, intramedullary nails or temporary joint spacers, placed when a patient develops an infection around a joint arthroplasty, requiring its removal.

These codes are used in place of established CPT codes 11981-11983, insertion, removal and removal with re-insertion of non-biodegradable drug delivery implants, which typically are for subcutaneous use.

Repair Codes
New verbiage changes for intermediate and complex repair codes were added to the integumentary section. The old guidelines did not define “limited” or “extensive” undermining. New verbiage for intermediate repair includes:

  • “Limited undermining” defined 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.

New verbiage for complex repair includes:

  • “Extensive undermining” defined as a distance greater than or equal to the maximum width of the defect, measured perpendicular to the closure line along at least one entire edge of the defect; involvement of free margins of helical rim, vermillion border, or nostril rim; placement of retention sutures.

ENT
A new tympanostomy (requiring insertion of ventilating tube) using an automated tube delivery system, iontophoresis; local anesthesia was added to the Ears, Nose and Throat (ENT) section. This code will be used when performed in the clinic setting and will replace CPT code 69436, which requires general anesthesia.

Imaging Guidance
For CPT 2020, image guidance will now be bundled into lumbar puncture codes; however, this only includes fluoroscopy and CT. The rationale for this decision is due to no other imaging guidance would ever be utilized.

Anatomic Modeling and 3D Printing
Anatomic Modeling and 3D printing codes are established with extra verbiage to aid users in distinguishing between the two. These codes are to be assigned for preoperative or preprocedural visualization, planning and patient consent. Verbiage states to code the structure component first and then each additional component. Codes 0559T and 0560T are for anatomic modeling and 0561T and 0562T are assigned for anatomic guidelines.

The Impact of CPT Code Changes on Your Healthcare Organization
The 2020 CPT code changes are complex. For a comprehensive listing of all additions, deletions and revisions, visit the 2020 CPT Code Book. This will give you the full list of updates and necessary adjustments to edit billing, chargemasters/fee schedules and other applicable areas within your EMR system.

It’s also important to communicate these changes to impacted individuals.

Unsure how to get started or have a question related to the changes?

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