Get Cozy with the 2019 HCPCS Updates

Posted on 29 Jan, 2019 |comments_icon 0|By Bruce Pegg

If the 2019 Healthcare Common Procedures Coding System (HCPCS) changes flew under your end-of-2018 radar, don’t feel bad. After all, like most of us, you probably spent the last part of last year paying attention to the annual ICD-10 and CPT® changes and staying on top of the Physician’s Fee Schedule (PFS) Final Rule and the first quarter National Correct Coding Initiative (NCCI) edits.

If you’re ready to catch up, though, we’ve got your back. Just grab your 2019 HCPCS Level II Advisor — and maybe a red pen or a highlighter — and we’ll guide you through the HCPCS codes list to identify some of the key 2019 HCPCS codes that could impact your coding this year and moving forward.

2019 HCPCS Additions Overview

Fortunately, the number of changes to this year’s HCPCS list are manageable. Altogether, there are 228 new, 49 discontinued, and 95 changed codes and modifiers.

Perhaps the most significant group of additions are the 72 new medical service, or M, codes. These are predominantly screening and documentation codes, and include seven codes, M1009-M1015, that you can use to document the final evaluation and completion of a patient’s treatment.

Of interest, too, are six new hearing aid codes (V5211-V5215 and V5221). You’ll also find one discontinued code in this section: V5220 (Hearing aid, bicros, behind the ear).

Temporary codes (category Q) and temporary codes for use with the Outpatient Prospective Payment System (PPS) (category C), too, receive a workout in this round of revisions. This is hardly a surprise, since these temporary codes are used to report “new technology and drugs” among other services and procedures according to HCPCS coding conventions. So, dermatology coders will need to be aware of the 21 new temporary codes for skin substitutes and biologicals (Q4183-Q4198 and Q4200-Q4204), while some specialties could be affected by the eight temporary injection codes in the Q category (Q5103-Q5110) and six in the C category (C9034-9039).

You’ll also find 27 new injected drugs to the J category, including seven new chemotherapy drugs, in this latest update.

Deletions and Replacements

Of the discontinued codes and modifiers, almost half (26) can be found in the C code section. But in numerous cases, CMS is actually replacing them with permanent codes, including many substitutions for injected drugs. Consequently, if you coded the brand-name drug Emend® with C9463 (Injection, aprepitant, 1 mg) in 2018, you’ll need to change over to J0185 (Injection, aprepitant, 1 mg). The same is true of the following:

  • Replace C9033 (Injection, fosnetupitant 235 mg and palonosetron 0.25 mg) with J1454 (Injection, fosnetupitant 235 mg and palonosetron 0.25 mg) (brand name Akynzeo®).
  • Replace C9031 (Lutetium lu 177, dotatate, therapeutic, 1 mci) with A9513 (Lutetium lu 177, dotatate, therapeutic, 1 millicurie).
  • Replace C9275 (Injection, hexaminolevulinate hydrochloride, 100 mg, per study dose) with A9589 (Instillation, hexaminolevulinate hydrochloride, 100mg).
  • Replace J9310 (Injection, rituximab, 100 mg) with J9311 (Injection, rituximab 10mg and hyaluronidase) and J9312 (Injection, rituximab, 10 mg) (brand name Rituxan®).

Coding caution: If your provider does administer Rituxan to patients, make sure you change the units in your system. Code J9310 had a unit value of 100mg; both the new codes have a unit value of 10mg.

One other replacement of note involves the deletion of breast cancer MRI temporary codes C8904 (Magnetic resonance imaging without contrast, breast; unilateral) and C8907 (Magnetic resonance imaging without contrast, breast; bilateral). Instead of these two codes, you’ll now only report a single temporary code: C8937 (Computer-aided detection, including computer algorithm analysis of breast MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation (list separately in addition to code for primary procedure)).

Coding caution: Remember, CPT® codes are superseded by Medicare-specific HCPCS codes on charge description masters (CDM) for Medicare, so be sure to use them rather than their CPT® counterparts. Commercial payers will, of course, have their own code preferences.

For the full list of current HCPCS codes, including all the new codes, codes deleted from the 2018 list, descriptor changes, and codes subject to payment changes, download the 2019 Alpha-Numeric HCPCS Zip File and open up the Excel file titled “HCPC2019_Trans_Alpha.”

Contributing Editor: Suzanne Burmeister

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Bruce Pegg
Editor, Newsletters

An experienced teacher and published author, Bruce is TCI’s new voice of primary care, delivering advice and insights every month for coders in the fields of family, internal, and pediatric medicine through Primary Care Coding Alert and Pediatric Coding Alert. Additionally, he is the current editor of E/M Coding Alert. Bruce has a Bachelor of Arts degree from Loughborough University in England and a Master of Arts degree from The College at Brockport, State University of New York. He recently became a Certified Professional Coder (CPC®), credentialed through AAPC.

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