CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care.

Major changes in the 2018 CPT® codebook include the addition of evaluation and management (E/M) codes to account for time spent assessing patients and managing patient care, as well as a host of new codes for nasal/sinus endoscopy and endovascular abdominal aortic repair (EVAR). Here’s a summary of the biggest changes in every chapter. 

E/M
A new code (99483, which replaces HCPCS G0505) reports assessment of and care planning for a new or established patient with cognitive impairment. The service includes 10 bulleted requirements, listed in the code descriptor. Per CPT®, the service may be reported once per 180 days.

New code 99484 replaces HCPCS code G0507 to report general behavioral health integration services, which incorporate collaborative care principles. The time-based service is reported once per month, and includes: initial assessment or follow-up monitoring; behavioral health care planning in relation to behavioral/psychiatric health problems; facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team.

Three new time-based codes (99492, 99493, 99494) report psychiatric collaborative care management (CoCM). Per the American Psychiatric Association, CoCM services:

…typically [are] provided by a primary care team consisting of a primary care physician and a care manager who work in collaboration with a psychiatric consultant, such as a psychiatrist. Care is directed by the primary care team and includes structured care management with regular assessments of clinical status using validated tools and modification of treatment as appropriate. The psychiatric consultant provides regular consultations to the primary care team to review the clinical status and care of patients and to make recommendations.

Finally, CPT® adds the term “outpatient hospital” to the descriptor of observation codes 99217-99220, to clarify that observation is specific to outpatient status (place of service 22).

Anesthesia
Codes for endoscopic upper and lower gastrointestinal procedures are replaced to improve reporting specificity. For example, 00740 is deleted and replaced by two new codes: 00731 Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified and 00732 … endoscopic retrograde cholangiopancreatography (ERCP). Similar new codes are introduced for lower intestinal endoscopic procedures (00811, 00812) and combined upper and lower endoscopic procedures (00813).

Integumentary
Two new codes report flaps (15730 Zygomaticofacial flap, and 15733 Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle).

Add-on code 19294 is added to report preparation of a tumor cavity and placement of a radiation therapy applicator for intraoperative radiation therapy, in addition to partial mastectomy procedures (19301, 19302).

Nasal/Sinus Endoscopy
Three new codes describe procedures performed at the same time as nasal/sinus endoscopy with total ethmoidectomy (removal of tissue from anterior and posterior ethmoid sinus):

• 31253 Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed


• 31257 … total (anterior and posterior), including sphenoidotomy


• 31259 … total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus

The new codes combine services reported by existing codes for procedures performed at the same time on the same (ipsilateral) side.

New code 31241 reports ligation of the sphenopalative artery during a nasal/sinus endoscopy (previously reported as an unlisted procedure, 30999).

Also, 32994 is added to differentiate cryoablation of pulmonary tumors from radiofrequency ablation therapy (reported with revised code 32998).

Artificial Heart Procedures
New Category I codes 33927-33929 replace Category III codes (0051T-0053T) for services related to total heart replacement.

EVAR
New codes 34701-34716 report services related to endovascular abdominal aortic repair. The procedures include determining the correct size and type of endograft to be used, deployment of the endograft, non-selective catheter placement, radiological supervision and interpretation, and angioplasty at the endograft site. CPT® includes a new section header and extensive parenthetical instructions to aid in reporting these codes.

With the introduction of the new codes, previous codes for endovascular repair of infrarenal abdominal aortic aneurysm (e.g., 34800 and others) are deleted, as are the associated radiology codes (e.g., 75952 Endovascular repair of infrarenal abdominal aortic aneurysm or dissection, radiological supervision and interpretation).

Vein Treatments
New codes 36465 and 36466 describe injection of non-compounded foam sclerosant with ultrasound compression, including imaging guidance and monitoring, for a single incompetent extremity truncal vein; or, for multiple incompetent truncal veins in the same leg, respectively.

Two new codes (36482 and 36483) describe endovenous ablation therapy of incompetent vein. A catheter is positioned in the full length of the incompetent vein and the adhesive is administered remote from the access site to collapse the vein.

Bone Marrow Aspiration Now Selected by Purpose
Bone marrow aspiration codes are now selected based on their purpose. For example, when coding bone marrow aspiration for spine surgery, select the new add-on code 20939 (when performed through a separate incision). For diagnostic bone marrow aspiration, report revised code 38220; for biopsy, report 38221. When an aspiration is both diagnostic and a biopsy, report 38222.

Esophagectomy
There are new and revised codes for esophagectomy:

• 43286 describes laparoscopic mobilization and pyloric drainage in combination of the open approach for a cervical pharyngogastrostomy or esophagogastrostomy.


• 43287 reports esophagectomy of the distal two-thirds using a laparoscopic mobilization and pyloric drainage, with separate thoracoscopic mobilization of the esophagus and thoracic esophagogastrostomy.


• 43288 describes thoracoscopic mobilization of the esophagus, laparoscopic proximal gastrectomy, pyloric drainage, and an open cervical pharyngogastrostomy or esophagogastrostomy.

Nerve Repair
New codes report nerve allograft (previously reported with unlisted code 64999): 64912 reports each nerve that is repaired using the first strand. If additional strands are used, report 64913.

Chest, Abdomen X-ray Now Reported by Number of Views
New codes for chest and abdomen radiologic exam specify the number of view taken. For example, 71045 now reports radiologic examination, chest; single view; 71046 is two views, 71047 is three views, and 71048 is four or more views. For abdomen, 74018 reports one view; 74019 reports two views, and 74021 reports three or more views.

Path and Lab
New code 81175 reports the full gene sequence analysis of ASXL1, which are frequently mutated genes in malignant myeloid diseases; 81176 reports the targeted sequence analysis test.

Levels 1, 2, and 4-7 molecular pathology codes are revised to exclude dozens of specific procedures that now are reported using new codes. For example, four new codes (81361-81364) report the gene analysis of HBB (hemoglobin, subunit beta), but previously were reported with Tier 2 code 81401.

Code 86794 reports the test used to identify antibody testing for immunoglobulin M (IgM) for Zika virus. Similar new codes report respiratory syncytial virus detection performed via detection of the infectious agent (87634), and for Zika virus detection performed via detection of the infectious agent (87662).

New Vaccines
Code 90756 reports a new influenza virus vaccine that is quadrivalent (ccIIV4), derived from cell cultures with preservative, and is antibiotic-free; 90682 reports a new influenza vaccine that is quadrivalent (RIV4), hemagglutinin (HA) protein-only influenza vaccine product that is preservative and antibiotic-free, and derived from recombinant DNA.

Code 90750, which appears in CPT® for the first time, describes intramuscular vaccination for shingles (recombinant, subunit, adjuvanted).

INR Services
Patients on warfarin require constant oversight and International Normalized Ration (INR) testing. New code 93792 reports the education for the patient or caregiver for home INR monitoring; 93793 reports the provider’s management and oversight. Codes 99363 and 99364 are deleted.