A look ahead to 2020 CPT changes

Each year the American Medical Association (AMA) releases the Current Procedural Terminology (CPT) code set changes for the upcoming year. For CPT 2020, the changes were released on September 4, 2019.  As in previous years, new instructions and guidelines have been added to multiple sections in the code set to clarify coding for CPT users. In addition to the guidelines, a total of 394 codes have been changed, of which 248 are newly established codes, 75 are revised codes and 71 codes are deleted. These changes will go into effect on January 1, 2020.

The most considerable changes have been made in the Medicine section, with the addition of 23 new codes for reporting long term electroencephalographic (EEG) monitoring services to monitor the electrical activity of the brain. These services are critical for monitoring patients with epilepsy.  Additionally, many new codes have been added and revised in the Surgery and Pathology & Laboratory sections of the CPT code set.

Following are highlights of the new code(s) additions pertaining to the main sections in the CPT code set:

Evaluation and Management:

• Three new codes (99421-99423) and new guidelines have been established for reporting online digital evaluation and management (E/M) services (e-visits).
• Two new codes (99473-99474) have been added for reporting self-measured home blood pressure monitoring using a validated device.
• A new add-on code 99458 has been established to report each additional 20 minutes of remote physiologic monitoring treatment management services.

Surgery:

• 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.
• In the Musculoskeletal subsection new guidelines and six new codes (20700-20705) have been added to report manual preparation and insertion of drug delivery devices and removal of drug delivery devices. In addition, two new codes (20560-20561) have been added to report needle insertions in muscles without injection(s) and three new codes (21601-21603) have been added to report excision of chest wall tumor.
• In the Cardiovascular subsection four new codes (33016-33019) along with new guidelines have been added to describe pericardiocentesis and pericardial drainage with insertion of indwelling catheter. Additionally, two new codes (33858-33859) and new guidelines have been added to describe ascending aortic graft, a new code 33871 has been added to report transverse aortic arch graft, two new codes (34717,34718) were added to report endovascular repair of the iliac artery and two new codes (35702-35703) have been added to report artery exploration in upper or lower extremities.
• In the Digestive subsection a new code 46948 was added to describe internal hemorrhoidectomy by dearterialization and two new codes (49013,49014) have been established to report preperitoneal pelvic packing and re-exploration with removal of preperitoneal pelvic packing.
• In the Nervous subsection two new codes (62328-62329) have been added to describe spinal puncture with fluoroscopic or CT guidance. In addition, four new codes (64451-64625) along with new guidelines have been added to describe injection of anesthetic agent and/or steroids into the somatic nervous system.
• In the Eye and Ocular Adnexa subsection two new codes (66987-66988) were added to describe extracapsular cataract removal.

Radiology:

• A new code 74221 has been established for a double-contrast radiologic examination of the esophagus.
• A new add-on code 74248 has been added for radiologic small intestine follow-through study.
• Five new codes (78429-78433) have been established to report myocardial imaging positron emission tomography (PET) studies with computed tomography (CT) transmission scan, as well as to report studies at rest and/or during stress. Add-on code 78434 has also been added to report absolute quantification of myocardial blood flow (AQMBF) previously reported with Category III code
• Three new codes (78830-78832) have been added to report nuclear medicine tomographic SPECT studies for radiopharmaceutical localization of tumor. Add-on code 78835 has been established to report radiopharmaceutical quantification measurement(s).

Pathology and Laboratory:

• Six new therapeutic drug assay codes have been established to describe the following: Adalimumab (80145), Infliximab (80230), Lacosamide (80235), Posaconazole (80187), Vedolizumab (80280) and Voriconazole (80285).
• Four new Tier I molecular pathology codes have been added:(81277) to describe cytogenomic neoplasia microarray analysis for chromosomal abnormalities and codes (81307-81309) to describe cancer gene analysis.
• Three new multianalyte assay codes with algorithmic analyses have been added: (81522) to describe oncology (breast), mRNA gene expression profiling of 12 genes; (81542) oncology (prostate), mRNA, microarray gene expression profiling of 22 content genes; and (81552) oncology (uveal melanoma), mRNA gene expression profiling of 15 genes.
• A new microbiology code 87563 has been added to report for mycoplasma genitalium, amplified probe technique.
• Seventy-five new codes (0062U-0138U) have been established to report proprietary clinical laboratory analyses (PLA).

Medicine:

• Two new vaccine codes have been established: 90694 for reporting Influenza virus vaccine for intramuscular use, quadrivalent (allV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, and code 90619 for reporting meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, tetanus toxoid carrier for intramuscular use.
• Two new codes (90912-90913) have been added for reporting biofeedback training, perineal muscles, including EMG and/or manometry when performed.
• Two new codes (92201-92202) have been added for reporting extended ophthalmoscopy.
• A new code 92549 has been established for reporting computerized dynamic posturography sensory organization test with motor control (MCT) and adaptation test (ADT).
• A new add-on code 93356 has been added to report myocardial strain imaging using speckle tracking.
• Two new codes (93985-93986) and new guidelines have been added to report duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access.
• Twenty-three new codes (95700-95726) and new guidelines have been established for reporting electroencephalographic (EEG) monitoring services.
• New guidelines and nine new codes (96156-96171) have been added to report health behavior assessment and intervention.
• Two new codes (97129-97130) have been added to report therapeutic intervention procedures that focus on cognitive function.
• New guidelines and three new codes (98970-98972) have been added to report online digital evaluation and management (E/M) services by qualified nonphysician health care professionals.

In addition to the main section changes, five new Category II codes have been established for performance measurement and fifty-one new Category III temporary codes have been established to track emerging technology services and procedures. 

It is always good practice to prepare your providers, coders and billing staff for the upcoming changes and make certain they receive adequate training. Thinking about infrastructure, your office systems and any administrative forms should be updated to accommodate the changes in the code set. It is important to have all this preparation completed prior to January 1. For a complete list of the changes and official CPT guidelines, refer to the 2020 CPT code book and Appendix B for the summary of additions, deletions and revisions. Stay tuned for additional blogs regarding specific section changes.

Danielle Pavloski is a quality manager for the CodeComplete team at 3M Health Information Systems.

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