Category III Codes
Category III CPT codes are released semi-annually, in January and July. There are 38 new, 29 deleted and 3 revised Category III codes. Review pages 764-789 of CPT book which indicate the new codes delineated by a red circle. Many of the Category III codes not discussed in the previous 4 parts of this series involve more diagnostic and testing procedures across all specialties. Of note is a new “Cellular and Gene Therapy” subsection. This subsection includes codes 0533T-0536T Continuous recording of movement disorder symptoms and 0537T-0542T Chimeric antigen receptor T-cell (CAR-T) therapy.
Use Category III codes first before regular surgical CPT codes.
For radiology there are 10 new codes, 6 deleted, and 4 revised. There are 6 new ultrasound and ultrasound with elastography codes scattered throughout the chapter (76391, 76978-76979, 76981-76983). Transient elastography gives a quantitative one-dimensional (i.e. a line) image of tissue stiffness. It functions by vibrating the skin with a motor to create a passing distortion in the tissue (a shear wave), and imaging the motion of that distortion as it passes deeper into the body using a 1D ultrasound beam.
There are 4 new magnetic resonance imaging of breast codes, 77046-77049. These codes now denote if without contrast or without and with contrast materials including CAD to reflect current practice. Old codes 77058,77059 have been deleted.
For this section there are 29 new codes, 13 deleted, and 17 revised Medicine CPT Codes.
1 new code 93264, is for remote monitoring of wireless pulmonary artery pressure sensor.
There are 7 new or revised neurostimulator monitoring codes. There is a new “Adaptive Behaviour Services – Assessments – Treatment” subsections and other CNS testing.
Laboratory and Pathology
There are 95 new codes, 5 deleted and 15 revised codes. Most of the new codes and revisions involve molecular pathology, which is a growing field. Since many of these codes are inputting in the pathology or laboratory departments via chargemaster, the hospital will want to be sure the chargemaster is up to date and personnel in these departments are aware of the updates.
Evaluation and Management
For E&M there are 6 new codes, and 5 revised codes. The subsection for “Interprofessional Telephone/Internet/Electronic Health Record Consultations” updated with “Electronic Health Record” along with the notes.
“Electronic Health Record” was added to codes 99446-99449 for interprofessional telephone/internet/electronic health record assessment and management service.
The below two new codes were created to reflect the growing use of the online electronic health record to interact with patients.
- 99451 Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating /requesting physician or other qualified healthcare professional, 5 minutes or more of medical consultative time
- 99452 Interprofessional telephone/internet/electronic health record referral services provided by a treating /requesting physician or other qualified healthcare professional, 30 minutes
Report 16-30 min of a service day for time spent preparing for the referral and/or communicating with
the patient using code 99452. If over 30 minutes, use prolonged services codes.
There is a new subsection for “Digitally Stored Data Services/Remote Physiologic Monitoring.” Report remote monitoring services such as weight, blood pressure, pulse oximetry during a 30 day period. The device must be a medical device as defined by the FDA.
- 99453 Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial, set-up and patient education on use of equipment
(Do not report more than once per episode of care or for monitoring under 16 days
- 99454 Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.
(Do not report for monitoring under 16 days or if monitoring covered under another code)
▲ 99091 Collection and interpretation of physiologic data code was updated with adding “each 30 days” so this code can only be reported once per 30 days
There is another new subsection “Remote Physiologic Monitoring Treatment Management Services” with notes.
- 99457 Remote physiological monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communications with the patient/caregiver during the month
This code is used when QHCP use the results of remote physiological monitoring to manage a patient under a specific treatment plan. It is also used when it does not meet requirements to report a more specific service. (Report once per 30 days regardless of the number of parameters monitored.
(Do not report 99457 with 99091)
One new code was created under the Chronic Care Management Services.
99491 Chronic care management services, provided personally by a physician or other QHCP at least 30 minutes of physician/QHCP time, per calendar month, with the following required elements:
- Multiple (2 or more) chronic conditions expected to last at least 12 months or death
- Chronic conditions place patient at risk of death, acute exacerbation or decline
- Comprehensive care plan established, implemented, revised or monitored
More E&M information in general:
Good news is CMS is delaying implementation of E/M payment changes. CMS will collapse payment rates for E/M office visits levels 2 through 4 rather than levels 2 through 5 beginning in 2021. CMS will keep a separate payment rate for level 5 visits to account for time and care associated with complex patients.
CMS has also eliminated the requirement to document the medical necessity of a home visit in lieu of an office visit.
For established patients history and exam, when relevant information is already contained in the medical record, practitioners may choose to focus their documentation on what has changed since the last visit, or on pertinent items that have not changed, and need not re-record the defined list of required elements if there is evidence that the practitioner reviewed the previous information and updated it as needed.
Additionally, CMS is clarifying that for new and established patients chief complaint and history, practitioners need not re-enter in the medical record information that has already been entered by ancillary staff or the beneficiary. The practitioner may simply indicate in the medical record that he or she reviewed and verified this information.
Beginning in CY 2021, CMS will implement payment, coding, and additional documentation changes for E/M office/outpatient visits, specifically:
- Single rates for levels 2 through 4 for established and new patients, maintaining the payment rates for E/M office/outpatient visit level 5 in order to better account for the care and needs of complex patients;
- Add-on codes for level 2-4 visits that describe the additional resources inherent in visits for primary care and particular kinds of non-procedural specialized medical care;
- A new “extended visit” add-on code for level 2 through 4 visits to account for the additional resources required when practitioners need to spend additional time with patients.
- For level 2 through 5 visits, choice to document using the current framework, MDM or time;
- When time is used to document, practitioners will document the medical necessity of the visit and that the billing practitioner personally spent the required amount of time face-to-face with the beneficiary (typical CPT time for code reported, plus any extended/prolonged time).
This concludes our five part series on new CPT codes for FY 2019! Happy Coding!
The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.