2019 CPT Code Set: Part 2

Posted on 10 Oct, 2018 |comments_icon 0|By Elizabeth
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Get a Jumpstart on the 2019 CPT® Code Set: Part 2

If you’re just joining our overview of CPT® code changes for 2019, you might want to back up and start at the beginning of this series. In Part 1 , we lay out E/M code additions for remote patient monitoring (RCM) and interprofessional Internet consultation.

Today, we continue our 2019 CPT® coding review with an in-depth look at noteworthy changes you don’t want to miss.

Get Acquainted with 9 New FNA Codes

Fine needle aspiration (FNA) codes undergo a major overhaul in 2019. CPT® code 10022 (Fine needle aspiration; with imaging guidance) will be deleted in 2019. To ramp up for a new approach to FNA coding, 10021 (Fine needle aspiration; without imaging guidance) has been revised. The new code descriptor will be (emphasis added): Fine needle aspiration biopsy, without imaging guidance; without imaging guidance first lesion.

CPT® 2019 adds nine new fine need aspiration biopsy (FNAB) codes, which will include radiological supervision and interpretation. In other words, modality of imaging guidance (ultrasound, fluoroscopy, CT, MR, or none) is specified in the code and will no longer be reported separately, as you’ll see in the code descriptors below. Also notice that there will be two codes for each imaging modality — a primary code for the first lesion and an add-on code for each additional lesion:

  • +10004… each additional lesion (List separately in addition to code for primary procedure)
  • 10005Fine needle aspiration biopsy, including ultrasound guidance; first lesion
  • +10006 each additional lesion (List separately in addition to code for primary procedure)
  • 10007Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion
  • +10008… each additional lesion (List separately in addition to code for primary procedure)
  • 10009Fine needle aspiration biopsy, including CT guidance; first lesion
  • +10010… each additional lesion (List separately in addition to code for primary procedure)
  • 10011Fine needle aspiration biopsy, including MR guidance; first lesion
  • +10012… each additional lesion (List separately in addition to code for primary procedure).

When your provider uses a different imaging modality on additional lesions, you’ll report more than one code and append modifier 59 (Distinct procedural service).

If, however, your provider performs an FNAB and core needle biopsy (CNB) on the same lesion, don’t report the image guidance for the CNB. You also want to see new instructional notes that define a FNAB and a CNB to clarify the differences between these two procedures.

Code Skin Biopsies with Expanded Options for Procedure Type

CPT® code 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion) — in addition to its add-on code +11101 for additional lesions — will be deleted for 2019. You’ll have six new codes in their place:

  • 11102Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion
  • +11103… each separate/additional lesion (List separately in addition to code for primary procedure)
  • 11104Punch biopsy of skin (including simple closure, when performed); single lesion
  • +11105… each separate/additional lesion (List separately in addition to code for primary procedure)
  • 11106Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion
  • +11107… each separate/additional lesion (List separately in addition to code for primary procedure).

Similar to the new codes for FNA, the new skin biopsy codes pair a primary code, identified by type of biopsy performed, with an add-on code to report each additional lesion. Here, too, you can look to new instructional notes that define a biopsy, as well as the different types of skin biopsy procedures.

Watch for Breast MRI with CAD

Unilateral and bilateral breast MRI codes, 77058 and 77059 respectively, which did not distinguish if contrast material(s) were used, will be deleted as of January 1. The 2019 CPT® code set replaces these two codes with four new codes — two representing procedures performed without contrast material(s) and two representing procedures performed with or without contrast material(s) but with CAD utilization. The four new codes are as follows:

  • 77046Magnetic resonance imaging, breast, without contrast material; unilateral
  • 77047… bilateral
  • 77048Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral
  • 77049… bilateral.
Get Up to Speed on Permanent Code Additions for Leadless Pacemakers

CPT® 2019 deletes three Category III codes — 0387T, 0388T, 0389T —and replaces them with two permanent codes for leadless pacemakers:

  • 33274Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed
  • 33275Transcatheter removal of permanent leadless pacemaker, right ventricular.

As well, new CPT® codes have been created for the insertion and removal of a subcutaneous cardiac rhythm monitor. You’ll use 33285 to report the insertion of the subcutaneous cardiac rhythm monitor. This code includes programming. The second new code, 33286, depicts the removal of the monitor.

The 2019 CPT® code set also includes the new code 33289, which is for a transcatheter implantation of a wireless pulmonary artery pressure sensor. You’ll use new code 93264 to report the remote monitoring of the wireless pulmonary artery pressure sensor for up to 30 days.

Introducing New Category III Codes for Cardiology

Among the many CPT® code updates heading your way if you’re a cardiology coder, you’ll have several new Category III codes with which to familiarize yourself. Take a peek at the 2019 lineup:

  • Wireless cardiac stimulator for left ventricular pacing codes: 0515T-0522T
  • Intraprocedural coronary fractional flow reserve (FFR) code: 0523T
  • Endovenous catheter directed chemical ablation with balloon isolation code: 0524T
  • Intracardiac ischemia monitoring system codes: 0525T-0532T.
Gear Up for New Central Nervous System Assessments & Adaptive Behavior Analysis Codes

2019 introduces new CPT® codes to the central nervous system assessments/tests range, most of which are time-based codes.

The first two of these new codes include the primary code 96112 for developmental test administration, and the add-on code +96113 to report each additional 30 minutes beyond the hour indicated in 96112.

CPT® code 96116 for neurobehavioral status exam has been revised as follows (emphasis added): Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), per hour of the psychologist’s or physician’s timeby physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour.

Use new add-on code +96121 to report each additional hour required to perform and interpret the neurobehavioral status exam.

You’ll also find four new codes for psychological test evaluations: 96130-+96133. Here, again, these four codes consist of two pairs, with one primary code and one add-on code to allot for addition time spent on the evaluation.

Additional codes will be available to report test administration and scoring. These codes – 96136-96146 – also indicate who scored the test.

Finally, there are eight new CPT® codes options added to adaptive behavioral services. The first of these is the primary assessment code:

  • 97151Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician’s or other qualified health care professional’s time face-to-face with patient and/or guardian[s]/caregiver[s] administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan.

Included in this code family is a new option to report the work of a provider serving in a supporting capacity under the direction of a physician or other qualified health care professional:

  • 97152Behavior identification-supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes.

You’ll choose from the remaining six codes, 97153-97158, to report services addressing specific treatment targets based on previous assessments.

Learn More

This overview, of course, represents merely the tip of the iceberg. With more than 300 code updates coming your way, you’ll want to start preparing for January 1st.

Conquer CPT® changes, improve coding efficiency, and boost reimbursement in 2019 with TCI’s Medical Coding Books:

AMA CPT® 2019 Professional Edition: Includes the complete 2019 CPT® code set with official descriptors, modifiers, CPT® official coding rules and guidelines, citations from CPT® Changes, CPT® Assistant, and Clinical Examples in Radiology, Appendixes, highlights and symbols for all 2019 coding, guidelines, and text changes, and more.

The 2019 Procedural Coding Advisor, the perfect companion to the AMA CPT® 2019 Professional Edition, includes coding, billing, and reimbursement alerts and symbols throughout the book, customized Alphabetic Index with thousands of entries that eliminate “See” cross-references, New/Revised/Deleted Codes Advice for 2019, G code equivalents for numerous CPT® codes, MACRA: MIPS and APMs training chapter, 60 stick-on tabs, more colored anatomical illustrations, foldout front and back covers with quick references to modifiers, and much more.

Author

Elizabeth


Elizabeth works on an array of projects at TCI, researching and writing about modern reimbursement challenges. Since joining TCI in 2017, she has also covered the nuts and bolts of cybersecurity, compliance with federal laws, and how to tap into the advantages of telehealth services.

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