2018 Coding Changes That Will Affect Physician Practices

The CPT® [i] manual for 2018 contains 314 code changes, including 172 new codes and 60 revised codes.  In addition, 82 codes were deleted and two new modifiers were added.  This article will describe the highlights of those changes, based on their adoption by the Centers for Medicare and Medicaid Services (CMS) for use in the Medicare program.  Commercial payers may differ from Medicare in their adoption of coding changes, and so practices are advised to monitor their claims denials in the early part of 2018 to be sure any modified codes are being accepted and paid by all carriers.

Quite a few of the 2018 CPT code revisions pertain to radiology [ii] and are covered in our companion article How the 2018 Coding Changes Will Affect Radiology Practices.  We will not repeat those here, but let’s investigate the other changes for 2018

Evaluation and Management (E&M)

Almost every medical practice uses E&M codes and the most common of them have not been changed.  However, there are 5 new codes for Behavioral Health and Cognitive Assessment services.  Here’s the crosswalk of those codes from 2017 to 2018:

HCPCS Code for 2017 CPT Code for 2018 Description
G0505 99483 Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian.
G0502 99492 Initial psychiatric collaborative care management

  • first 70 minutes in the first calendar month of behavioral health care
  • in consultation with a psychiatric consultant and directed by the treating physician or other qualified professional
G0503 99493 Subsequent psychiatric collaborative care management

  • first 60 minutes in a subsequent month of behavioral health care.
G0504 99494

Add-on

Initial or Subsequent psychiatric collaborative care management

  • each additional 30 minutes in a calendar month of behavioral health care
G0507 99484 Care Management services for behavioral health conditions

  • at least 20 minutes of clinical staff time
  • directed by a physician or other qualified professional
  • use once per calendar month
  • use with 99497-99498

Four Observation Codes (99217-99220) have been revised to specify that they are to be used in the Outpatient Hospital location.

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Integumentary System

Wound reconstruction codes were modified as follows:

  • CPT 15730 has been added to describe Midface skin flap reconstruction (i.e., zygomaticofacial flap) with preservation of vascular pedicle(s).
  • CPT 15733 replaces 15732 for Muscle, myocutaneous or fasciocutaneous flap and adds buccinators and genioglossus to the muscles previously described.

CPT 17250 Chemical cauterization of granulation tissue now includes only proud flesh, deleting sinus or fistula from the description.

Mastectomy codes 19301 and 19302 will have the following available add-on code:

CPT 19294 Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with partial mastectomy.

Respiratory System

There are 5 new codes and 3 revised codes related to Nasal Sinus Endoscopy:

CPT Code Differential Description
31241
New
With ligation of sphenopalatine artery

31253
New

With ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus when performed.
31257
New
With ethmoidectomy; total (anterior and posterior), including sphenoidotomy
31259
New
With ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus
31298
New
With dilation of frontal and sphenoid sinus ostia (e.g., balloon dilation)
31254
Revised
Nasal/sinus endoscopy, surgical with ethmoidectomy; partial (anterior)
31255
Revised
Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior)
31276
Revised
With frontal sinus exploration, including removal of tissue from frontal sinus, when performed.  Previously worded with or without removal of tissue from frontal sinus.

Cardiovascular System

The coding for Total Heart Replacement now uses Category I codes that replace similar Category III codes.  Note that the new descriptions do not match up exactly with those that were replaced.

Code for 2017 Code for 2018 Description
0051T 33927 Implantation of a total replacement heart system (artificial heart) with recipient cardiectomy
0052T 33928 Removal and replacement of total replacement heart system (artificial heart)
0053T 33929

Add-on

Removal of a total replacement heart system (artificial heart) for heart transplantation.

  • Use in conjunction with CPT 33945 Heart transplant, with or without recipient cardiectomy.

Lymphatic System

This new code has been added to Laparoscopic Lymph Node Procedures:

CPT 38573 Laparoscopy, surgical, with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling, peritoneal washings, peritoneal biopsy(ies), omentectomy, and diaphragmatic washings, including diaphragmatic and other serosal biopsy(ies), when performed.

Digestive System

There are 3 new and 1 revised Esophagectomy codes, as follows:

CPT Code Description
43286
New
Esophagectomy, total or near total, with laparoscopic mobilization of the abdominal and mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngogastrostomy or esophagogastrostomy (i.e., laparoscopic transhiatal esophagectomy)
43287
New
Esophagectomy, distal two-thirds, with laparoscopic mobilization of the abdominal or lower mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with separate thoracoscopic mobilization of the middle and upper mediastinal esophagus and thoracic esophagogastrostomy (i.e., laparoscopic thoracoscopic esophagectomy, Ivor Lewis esophagectomy)
43288
New
Esophagectomy, total or near total, with thoracoscopic mobilization of the upper, middle, or lower mediastinal esophagus, with separate laparoscopic proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngogastrostomy or esophagogastrostomy (i.e., thoracoscopic, laparoscopic and cervical incision esophagectomy, McKeown esophagectomy, tri-incisional esophagectomy)
43112
Revised
Total or near total esophagectomy, with thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or without pyloroplasty (i.e., McKeown esophagectomy or tri-incisional esophagectomy) – the phrase in italics was added for 2018.

Genital System

Both the male and female genital systems incurred new, revised and deleted procedure codes, as follows:

CPT Code Description
55874
New
Transperineal placement of biodegradable material, periprostatic, single or multiple injection(s), including image guidance, when performed.
55450
Deleted
Ligation (percutaneous) of vas deferens, unilateral or bilateral (separate procedure)
58575
New
Laparoscopy, surgical, total hysterectomy for resection of malignancy (tumor debulking), with omentectomy, including salpingo-oophorectomy, unilateral or bilateral, when performed
57240
Revised
Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele, including cystourethroscopy, when performed
57260
Revised
Combined anteroposterior colporrhaphy, including cystourethroscopy, when performed
57265
Revised
Combined anteroposterior colporrhaphy, including cystourethroscopy, when performed, with enterocele repair

Nervous System

Nerve repair and neurostimulator services have been revised as follows:

CPT Code Description

64912
New

Nerve repair, with nerve allograft, each nerve, first strand (cable)
64913
New
Add-on
each additional strand
64550
Revised
Application of surface (transcutaneous) neurostimulator (e.g., TENS units) – the phrase in italics was added for 2018
64565
Deleted
Percutaneous implantation of neurostimulator electrode array; neuromuscular
69820
Deleted
Fenestration semicircular canal
69840
Deleted
Revision fenestration operation

Pathology and Laboratory

The majority of the 41 new pathology codes are new genetic testing codes.  Many of the new codes were previously bundled into a single molecular pathology procedure.

There are two new Zika virus test codes, 86794 (Zika virus, IgM) and 87662 (Zika virus, amplified probe technique), along with some changes to the family of drug screen codes.

A total of 12 Pathology and Laboratory codes were deleted, encompassing a variety of procedural areas.

Medicine

The Medicine section underwent numerous code revisions in the areas of:

  • Vaccinations (90651, 90620, 90621)
  • Pulmonary Stress Testing (94621)
  • Glucose Monitoring (95250, 95251)
  • Neurotransmission Studies (95930)
  • Photodynamic Therapy (96567)
  • Orthotic and Prosthetic Training (97760, 97761)

New codes were added for flu vaccine, shingles vaccine and anticoagulation services, as follows:

CPT Code Description
90587 Dengue vaccine, quadrivalent, live, 3 dose schedule, for subcutaneous use; (pending FDA approval)
90756 Influenza virus vaccine, quadrivalent [ccIIV4], derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
90682 Influenza virus vaccine, quadrivalent [RIV4], derived from recombinant DNA, hemagglutinin [HA] protein only, preservative and antibiotic free, for intramuscular use
90750 Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for intramuscular use*
93792 Patient caregiver training for initiation of home international normalized ratio (INR) monitoring under the direction of a physician or other qualified health care professional, face-to-face, including use and care of the INR monitor, obtain blood sample, instructions for reporting home INR test results, and documentation of patient’s/caregiver’s ability to perform testing and report results
93793 Anticoagulant management for a patient taking warfarin, must include review and interpretation of a new home, office, or lab international normalized ratio (INR) test result, patient instructions, dosage adjustment (as needed), and scheduling of additional test(s), when performed

* Medicare payment was effective for 2017, but the code was not previously listed in the CPT book.

New codes were also added for the following procedures and services:

CPT Code Description
94617 Exercise test for bronchospasm, including pre- and post-spirometry, electrocardiographic recording(s), and pulse oximetry
94618 Pulmonary stress testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed
95249 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; patient-provided equipment, sensor placement, hook-up, calibration of monitor, patient training, and printout of recording
96573 Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day
96574 Debridement of premalignant hyperkeratotic lesion(s) (i.e., targeted curettage, abrasion) followed with photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day
97127 Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact
97763 Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes

Two medicine codes, related to Development of Cognitive Skills (97532) and Orthotic/Prosthetic Training (97762), were deleted.

Conclusion

As noted at the outset, claims denials should be monitored carefully early in 2018 to be sure any coding revisions made by the practice are being processed correctly by Medicare and commercial payers.  It is quite possible that different codes will be required to describe the same procedure, depending on the acceptance of coding changes by the various payers.

The overall effect of coding changes is influenced by the volume of each code’s usage in a particular practice, and by the value assigned to the codes by the payers.  This is especially true where revisions have resulted in the bundling of payment under a single code that previously was reported using several separate codes.  A volume-weighted analysis based on the preceding year’s activity will generally give a good estimation of the effects of the CPT code changes we have described.

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Related Articles:

An Essential Transition from In-House to Outsourced Coding Services

How Should Physician Practices Approach the Revised CMS Student Documentation Rules?

Regulatory Changes Affecting Physician Reimbursement in 2018

Looking to change medical coding vendors? Contact HAP to see what we can do for your practice. 

[i] Current Procedural Terminology (CPT) is a copyrighted code set developed and maintained by the American Medical Association, and CPT is a registered trademark.

[ii] The following areas are described in the Radiology Article:

Mammography
Chest X-ray
Abdominal X-ray
Extremity Ultrasound
Nuclear Medicine
Endovascular Repair
Pulmonary Tumor Cryoablation
Incompetent Vein Treatment
Bone Marrow Aspiration
Brachial Artery Catheterization