With all the excitement about Medicare and AMA plans for E/M in 2021, don’t forget that the CPT® code set will have changes in 2020, too. The official code set will be out soon, but, in the meantime, here are some hints from the AMA about the changes you’ll have to know for Jan. 1. We’ll stick to Category I codes in this post.
Ace Add-On Coding for Bilateral Procedures
You’ll want to watch for a revision to instructions for bilateral procedures. The CPT® instructions throughout the code set will state that you should report add-on codes two times when the provider performs the procedure bilaterally. You should not use modifier 50 (Bilateral procedure) with add-on codes, the revised instructions will state. This news is in the May 2019 CPT® Editorial Summary of Panel Actions.
Bring E/M Into the Digital Future
Watch for three new E/M codes to represent patient-initiated digital communications by a physician or other qualified healthcare professional. Three new Medicine section codes will have similar codes for services by a nonphysician healthcare professional. To make room, expect the deletion of online service codes 99444 and 98969.
For remote physiological monitoring, there will be a new add-on code, +994xx, for additional time. Check the September 2018 CPT® Editorial Summary of Panel Actions for announcement of these changes.
Needle With No Injection? Review These Additions
Dry needling and trigger point acupuncture will have two new 205xx codes for needle insertion without injection (September 2018 summary).
Keep Up With Circulatory System Changes
The CPT® 2020 code set will include many changes for cardiovascular coders. All of the items below are in the September 2018 summary.
If you code for pericardiocentesis and pericardial drainage, prepare for four new codes to more accurately describe these services with deletion of current codes 33010, 33011, and 33015.
Current code 0254T (Endovascular repair of iliac artery bifurcation …) will be deleted, but there will be two new 30000 range codes (one an add-on) for endovascular iliac artery repair procedures.
Major artery exploration will have two new codes plus a revision to carotid artery exploration code 35701 to describe neck artery exploration. Watch for the deletion of artery exploration codes 35721, 35741, and 35761 from the 2020 code set.
Expect Lumbar and SI Changes
For lumbar puncture, two new 62xxx codes will include guidance. Check revisions to spinal puncture codes 62270 and 62272 and to the introductory guidelines, too.
Two new 60000 range codes will apply to injection and destruction of nerves innervating the sacroiliac joint for somatic nerve procedures (radiofrequency neurotomy).
The changes above are in the September 2018 summary.
Ready for Radiology Updates?
Big changes are coming for SPECT codes with the deletion of nine codes, revision of 78800-78804 to report single areas, and addition of four more codes to report different areas (September 2018 summary).
At the May 2019 meeting, the panel accepted revision of 74022 (Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest) to specify the number of views of the abdomen.
Look for Lots of Lab Updates
The May 2019 meeting resulted in these decisions:
- The lab range will see separate code additions for therapeutic drug monitoring of adalimumab, infliximab, lacosamide, posaconazole, vedolizumab, and voriconazole.
- Analysis of CN-SNP array will have its own Tier 1 code.
- Other codes will see revisions, such as UGT1A1 code 81350 removing irinotecan metabolism and including hyperbilirubinemia (Gilbert syndrome) and Level 5 molecular pathology code 81404 including UGT1A1 hyperbilirubinemia Crigler-Najjar syndrome.
- There will be a new MAAA code to report a 12-gene test to measure tumor biology of breast cancer and another to report prostate cancer metastasis risk score.
- Mycoplasma genitalium infectious agent detection will have its own code in the lab section, too.
- Stay tuned for a new symbol that will show a PLA code has been approved for Category I status but will stay in the PLA section.
Two new Tier 1 codes will report analysis of PALB2, full gene sequence. The 2020 code set will revise molecular pathology Level 7 code 81406 to report PALB2 testing. And you’ll have a new Tier 1 code to report PIK3CA analysis. All of that was reported in the February 2019 Editorial Summary of Panel Actions.
There also will be a new MAAA code to describe analysis of metastasis risk of uveal melanoma (September 2018 summary).
Make Room for More Medicine Codes
The Medicine section of CPT® covers a lot of specialty areas, and the code updates for 2020 are wide-ranging.
There will be a new code in the 90000 range for quadrivalent inactivated-adjuvanted influenza virus (allV4) vaccine (February 2019 summary).
The September 2018 summary reported there will be two new 90xxx codes (one an add-on) for biofeedback training. Related code 90911 will no longer be available. Motor control testing will have a new 92xxx code, and 92548 (Computerized dynamic posturography) will see a revision to reflect additional equipment.
There will be two new 93xxx codes for duplex scan of arterial inflow-venous outflow of the upper extremity (September 2018 summary).
The modifier 63 (Procedure performed on infants less than 4 kg) listing will no longer include +93463 (Pharmacologic agent administration …) and 93505 (Endomyocardial biopsy) (May 2019 summary).
These final changes below are all in the September 2018 summary:
- Plan for two new 99xxx codes for self-measured blood pressure monitoring with revision of ambulatory blood pressure monitoring codes 93784-93790.
- Myocardial strain imaging will move from Category III to Category I as an add-on code (+933xx).
- You won’t see the term impulse in the descriptor for 94728 (Airway resistance by impulse oscillometry) in 2020.
- The panel agreed to delete manual muscle testing codes 95831-95834.
- Stay alert for nine new codes for health and behavior assessment and intervention services, paired with the deletion of 96150-96155.
- For cognitive function intervention, there will be two new codes (one an add-on for additional time), with deletion of 97127.
Know Your Sources
The information above is from various CPT® Editorial Summaries of Panel Actions from the past year. The overview isn’t a complete list and some changes for 2020 were accepted more than a year ago (for instance, check out the May 2018 summary). The introduction to each of those summaries states, “Premature release of coding information other than that contained in this document is prohibited under the CPT® Confidentiality Agreement. Codes are not assigned, nor exact wording finalized, until just prior to publication.”
What About You?
Which CPT® 2020 changes will have the biggest impact on you?