Revenue Cycle Management Blog | GroupOne Health Source

A Review of the 2018 CPT Code Set Updates

Written by Kaitlyn Houseman | December 14, 2017

The new year is almost here meaning it is time for new Current Procedural Terminology (CPT) code changes! The 2018 CPT code set comes with a number of changes that may affect claims processing so it's time to start reviewing which codes affect your practice in order to prevent revenue cycle management disruptions. 

If you want to access a full list of code revisions, deletions, and additions, you can download our 2018 CPT code guide here. In this post, however, we're just going to highlight a few changes that are significant to most practices.

E/M Code Changes

  • Observation code descriptions changed from "admission to observation status" to "outpatient hospital observation status"
  • Change for initial OBS and discharge codes, 99218-99220 and 99217.
  • Domiciliary, rest home, or custodial care now include the terminology "group home, custodial care and intermediate care facilities"
Anti-coagulation management codes 993643 and 99364 are deleted. Codes 93792 Patient/caregiver training for initiation of home INR monitoring and 93793 Anticoagulant management for patient taking warfarin serve as replacements. 
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, obtaining 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

 

New E/M Codes

99483 replaces HCPCS code G0505

99483: Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home.

  • May only be reported once in every 180 days
  • Assessment of patient with Alzheimer's or dementia at any stage of impairment
  • Cognition-focused evaluation including a pertinent history and examination
  • Use of standardized instrument to stage dementia
  • Performed by a CMS stated physician/NP/PA
  • Requires creation of a written care plan, including initial plans to address any neuropsychiatric symptoms, neuro-cognitive symptoms, functional limitations, and referral to community resources as needed (eg, rehabilitation services, adult day programs, support groups) shared with the patient and/or caregiver with initial education and support.
  • Typically, 50 minutes are spent face-to-face with the patient and/or family or caregiver

 

Psychiatric Collaborative Care Management

The replacement of HCPCS codes with new CPT codes for 2018 shows a clear emphasis on behavioral health and presents an opportunity for primary care physicians to expand their care delivery and get reimbursed for the role they play in a patients psychiatric health.

These codes require the direction by a physician or qualified health care professional (QHCP) of behavioral health care manager activities in a calendar month. These also require a psychiatric consultant who does not need to see the patient but consults with the PCP team. Here are the four codes you will find in the E/M and Psychiatry section of the 2018 CPT Code Guide.

  • 99492 replaces HCPCS code G0502: Initial psychiatric collaborative care management; first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional.
  • 99493 replaces HCPCS code G0503: Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional.
  • 99494 replaces HCPCS code G0504: Initial or subsequent psychiatric collaborative care management each additional 30 minutes in a calendar month; use in conjunction with 99492 or 99493
  • 99484 replaces HCPCS code G0507: Care management services for behavioral health conditions; at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional. This code results in lower payment but take up less time and doesn't require a behavioral health manager or psychiatric consultation

Anesthesia CPT Codes

Five codes are being added for Anesthesia.

00731
Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified
00732 Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; endoscopic retrograde cholangiopancreatography (ERCP)
00811
Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; endoscopic retrograde cholangiopancreatography (ERCP)
00812 Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy
00813 Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum

 

Anesthesia service codes for extrapelvic (01180) and intrapelvic (01190) obdurator neurectomy and shoulder cast application, removal or repair; shoulder spica (01682) will be deleted.
 

Digestive Anesthesia

Codes 00740 Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum and 00810 Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum are being deleted. 
 
To report 00740, see codes 00731 Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified and 00732 Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; endoscopic retrograde cholangiopancreatography (ERCP).
 

Bundling

Each year, codes that are reported together more than 75% of the time are referred to the AMA CPT Editorial Panel. New codes are then created in order to describe services frequently reported together and new RVU values are assigned which often results in lower RVU units. 

This year, endovascular repair of aorta and endovenous ablation of incompetent veins has been bundled. See the Vascular section of the 2018 CPT Code Guide for more information on codes 34701-34716.

Pathology, Lab, and Diagnostic

Pathology, labs, and diagnostics each have a number of changes taking place in 2018. A bulk of the new pathology codes are new genetic testing codes. 
 
Some of the noteworthy additions include two new Zika virus tests 86794 (Zika virus, IgM) and 87662 (Zika virus, amplified probe technique). There is also an additional flu-vaccine code 90756 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use.
 
Radiology changes include the deletion of chest x-ray codes 71010-71035. Instead, next year you will report these services based on the number of views.
 
71010 Radiologic examination, chest; single view, frontal To report, use 71045
71015 Radiologic examination, chest; stereo, frontal To report, use 71045
71020 Radiologic examination, chest, 2 views, frontal and lateral To report, use 71046
71021 Radiologic examination, chest, 2 views, frontal and lateral; with apical lordotic procedure To report, use 71047
71022 Radiologic examination, chest, 2 views, frontal and lateral; with oblique projections To report, use 71047 or 71048
71023 Radiologic examination, chest, 2 views, frontal and lateral; with fluoroscopy To report, see 71046,76000, 76001
71030 Radiologic examination, chest, complete, minimum of 4 views To report, use 71048
71034 Radiologic examination, chest, special views (eg, lateral decubitus, Bucky studies) To report, see 71048, 76000
71035 Radiologic examination, chest, special views (eg, lateral decubitus, Bucky studies)  To report see 71046, 71047, 71048
 
X-rays of the abdomen will receive the same treatment. Codes 74000-74020 will be deleted and replaced by 74018, 74019, and 74021.