CPT/HCPCS Changes for 2020

The American Medical Association’s (AMA’s) 2020 update of the Current Procedural Terminology (CPT) code set includes 394 code changes, with 248 new codes, 71 deletions, and 75 revisions.

The Current Procedural Terminology, (CPT) code set for 2020 includes a few updates of interest to ob-gyns. 

As in previous years, extensive new instructions and guidelines have been added to the CPT manual to help clarify coding in a variety of situations. For 2019 a number of changes involve updates to evaluation and management codes and guidelines related to non-face-to-face services. This new guidance is in addition to new, revised, and deleted CPT codes for 2020. These changes are effective as of January 1, 2020.

HIPAA requires insurers to accept new procedure codes beginning on January 1st.

The American Medical Association CPT Editorial Panel approved these changes for 2020.


EVALUATION AND MANAGEMENT

Online Digital Evaluation and Management Services

Code 99444, Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network, has been deleted and replaced with codes:

New code(s):

#● 99421 – Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes

#● 99422 – Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes

#● 99423
– Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes

Online Digital E/M Services:

Services must be initiated by the patient
It must be a service that requires evaluation (not simply providing test results, etc.)
Cannot be billed within 7 days before or after an E/M service
Cannot be billed during a post-operative period

Digitally Stored Data Services/Remote Physiologic Monitoring

Two New Codes:

#● 99473 – Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration

#● 99474 – Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration; separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient

Remote Physiologic Monitoring Treatment Management Services

#99457 has been revised for clarification and reads: 

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes

New Code(s):

#+● 99458 – Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes (List separately in addition to code for primary procedure)


Qualified Nonphysician Health Care Professional Online Digital Evaluation and Management Service

New Code(s):

● 98970 – Qualified nonphysician health care professional online evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes

● 98971 – Qualified nonphysician health care professional online evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes

● 98972 – Qualified nonphysician health care professional online evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes


Digestive System

Two new codes:

● 49013 – Preperitoneal pelvic packing for hemorrhage associated with pelvic trauma, including local exploration
● 49014 – Re-exploration of pelvic wound with removal of preperitoneal pelvic packing, including repacking, when performed


RADIOLOGY

Nuclear Medicine

Codes for MRI of the breast have been deleted
Three new codes for radiopharmaceutical localization of tumor added and distinguished by 
Number of anatomic areas 
Single day vs multiple day imaging
Determination/detection of pathology

Codes 77058 - Magnetic resonance imaging, breast, without and/or with contrast material(s); unilateral and 77059 - Magnetic resonance imaging, breast, without and/or with contrast material(s); bilateral have been deleted. The following new codes for magnetic imaging of the breast replace them.

New Code(s):

● 78830 – Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, single area (eg, head, neck, chest, pelvis), single day imaging

● 78831 – Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT), minimum 2 areas (eg, pelvis and knees, abdomen and pelvis), single day imaging, or single area imaging over 2 or more days

● 78832 – Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, minimum 2 areas (eg, pelvis and knees, abdomen and pelvis), single day imaging, or single area imaging over 2 or more days


PATHOLOGY AND LABORATORY

More codes were added to Pathology and Laboratory section:

Molecular Pathology

New Code(s):

#● 81277 – Cytogenomic neoplasia (genome0wide) microarray analysis; interrogation of genomic regions for copy number and loss-of-heterozygosity variants for chromosomal abnormalities

#● 81307– PALB2 (partner and localizer of BRCA2) (eg, breast and pancreatic cancer) gene analysis; full gene sequence

#● 81308– PALB2 (partner and localizer of BRCA2) (eg, breast and pancreatic cancer) gene analysis; known familial variant

#● 81309– PIK3CA (phosphatidylinositol-4, 5-biphosphate 3-kinase, catalytic subunit alpha) (eg, colorectal and breast cancer) gene analysis, targeted sequence analysis (eg, exons 7, 9, 20)

Multianalyte Assays with Algorithmic Analyses

New Code(s):

#● 81522– Oncology (breast), mRNA, gene expression profiling by RT-PCR of 12 genes (8 content and 4 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as recurrence risk score

Microbiology

New Code(s):
● 87563 – Mycoplasma genitalium, amplified probe technique


MEDICINE

Health Behavior Assessment and Intervention
Nine new codes were added to this section: 96156, 96158, 16159, 96164, 96165, 96167, 96168, 96170, 96171

● 96156 – Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)
● 96158 – Health behavior intervention, individual, face-to-face; initial 30 minutes
● 96159 – Health behavior intervention, individual, face-to-face; each additional 15 minutes (List separately in addition to code for primary service)
● 96164 – Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes
● 96165 – Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 minutes (List separately in addition to code for primary service)
● 96167 – Health behavior intervention, family (with the patient present), face-to-face; initial 30 minutes
● 96168 – Health behavior intervention, family (with the patient present), face-to-face; each additional 15 minutes (List separately in addition to code for primary service)
● 96170 – Health behavior intervention, family (without the patient present), face-to-face; initial 30 minutes
● 96171 – Health behavior intervention, family (without the patient present), face-to-face; each additional 15 minutes (List separately in addition to code for primary service)







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