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CPT/HCPCS Changes for 2020

The AMA's 2020 update of the CPT code set includes 394 code changes, with 248 new codes, 71 deletions, and 75 revisions.

The CPT code set for 2020 includes a few updates of interest to obstetrician–gynecologists. 

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 1.

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: 

● 99421: Online digital evaluation and management service, for an established patient, for up to seven days, cumulative time during the seven days; five to 10 minutes

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

● 99423:
 Online digital evaluation and management service, for an established patient, for up to seven days, cumulative time during the seven 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 seven days before or after an E/M service
‣ Cannot be billed during a postoperative 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

 ● Δ 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:

#+● 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 Codes:

● 98970: Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to seven days, cumulative time during the seven days; five to 10 minutes

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

● 98972: Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to seven days, cumulative time during the seven 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 versus multiple-day imaging
‣ Determination or 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 Codes:

● 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 two areas (eg, pelvis and knees, abdomen and pelvis), single day imaging, or single area imaging over two 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 two areas (eg, pelvis and knees, abdomen and pelvis), single day imaging, or single area imaging over two or more days

Pathology and Laboratory

More codes were added to Pathology and Laboratory section:

Molecular Pathology

New Codes:

● 81277: Cytogenomic neoplasia (genome-wide) 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:

● 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:

● 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 (two or more patients), face-to-face; initial 30 minutes
+● 96165: Health behavior intervention, group (two 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)