New CPT® Codes and Descriptors for 2018 Released by AMA

New CPTÂŽ Codes and Descriptors

for 2018 Released by AMA

The article discusses the new CPT codes released by the AMA during its 2018 CPT and RBRVS symposium held in Chicago from November 15-17, 2017.

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The American Medical Association (AMA) recently announced significant changes to the 2018 CPT® codes and descriptors. Healthcare practices and medical coding companies need to get prepared to implement the new coding changes and guidelines coming up in 2018. The changes include about 170 new CPT codes, 60 revised codes and 82 deleted codes and these amount to a total of 312 edits in CPT for the year 2018 and a total of 10,155 code sets. The recent CPT code changes are related to different sections namely, Evaluation and Management (E&M), Anesthesia, Radiology, Surgery, Path and Lab and PLA codes. These specific updates include new, revised and deleted codes. In addition, there are two newly created modifiers for use in 2018.

New Modifiers for Habilitative and Rehabilitative Services The two new modifiers are reported with services that are identified as being either habilitative or rehabilitative in naturesuch as physical medicine and rehabilitation codes.

This enables the payer to differentiate habilitative from rehabilitative services.



Modifier 96- Habilitative Services – In this section, when a specific service or procedure (that may be either habilitative or rehabilitative in nature) is provided for habilitative purposes, the physician may need to add Modifier 96 to the service or procedure code to indicate that the specific service or procedure provided was habilitative. Habilitative services help an individual keep, learn, or improve skills and functioning for daily living.



Modifier 97- Rehabilitative Services – When a service or procedure (that may be either habilitative or rehabilitative in nature) is provided for rehabilitative purposes, the physician may add Modifier 97 to the service or procedure code to indicate that the service or procedure provided was rehabilitative.

The above mentioned differentiation in services is required by the Patient Protection and Affordable Care Act (PPACA).

New 2018 CPT Code Changes Evaluation and Management (E&M) Codes 

Three new codes for psychiatric collaborative care management services – G0502, G0503 and G0504 are replaced in 2018 with the new 99492, 99493 and 99494 CPT codes.

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

One new code for general behavioral health integration care service - Code 99484 describes at least 20 minutes of clinician time spent per month Revision of four observation care services



Deletion of two anticoagulation management service codes and creation of two new codes for INR home and outpatient INR monitoring services

Anesthesia Codes AMA has created two new upper gastrointestinal endoscopic procedure anesthesia codes and deleted one code. The code 00740 - Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum has been deleted. This has been replaced by two new codes namely – 

00731 - (Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified).



00732 - (…; endoscopic retrograde cholangiopancreatography [ERCP])

Similarly, Code 00810 - Procedures to the lower intestine using an endoscope introduced distal to the duodenum, has also been deleted for 2018. In its place, new codes 00811, 00812, and 00813 have been introduced. 

00811

–

(Anesthesia

for lower intestinal

endoscopic procedures,

endoscope

introduced distal to duodenum; not otherwise specified) 

00812 – (…; 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 due to the low volume of these procedures.

Surgery and Radiology Codes The surgery and radiology codes section contain some interesting updates and changes for the year 2018. Let’s begin with the general surgery medical coding sectionThere are about 16 new codes or five revised and 13 deleted codes in the endovascular section of the CPT code book. These codes are related to - Endovascular repair of abdominal aorta and/or Iliac arteries with an emphasis upon repair using endografts, extension

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prosthesis, and concepts of delayed placement of prosthesis for endovascular repair of vessels. The coding of these procedures is now determined by “treatment zone” rather than the “targeted treatment zone. ”Any procedure that is accomplished to treat vessel(s) beyond the “targeted treatment zone” could be separately reported. This zone is defined as those vessels that contain - an endogragft(s), including the main body, docking limbs and extensions deployed during an operation. On the other hand, the treatment zone includes all vessel(s) that are treated by the endograft.

Diagnostic Radiology – Under diagnostic radiology, there are four new codes for chest Xrays, accompanied by nine deletions associated with chest X-rays being categorized by the number of views.

Chest X-ray codes 71010-71035 will be deleted. For new code additions are created to report chest x-ray procedures described by the number of views versus view-specific descriptors. 

71045 (Radiologic examination, chest; single view)



71046 (…; 2 views)



71047 (…; 3 views)



71048 (…; 4 or more views)

In addition, X-rays of the abdomen will receive the same treatment. Codes 74000-74020 will be deleted and replaced by the following codes 

74018 (Radiologic examination, abdomen; 1 view)



74019 (…; 2 views)



74021 (…; 3 or more views)

Under plastic surgery, there are two new codes for muscle flaps, 15730 and 15733, to facilitate the capture and reporting of flap grafts involving the midface and head and neck.

Photodynamic therapy is an FDA-approved treatment for pre-malignant skin lesions known as actinic keratosis (AK), but it is not the only treatment for AK. 

CPT code 96573 – Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitive drug(s), per day

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The service represented in this code is quite distinct from CPT code 96574, as the latter procedure includes debridement of the premalignant hyperkeratotic lesion(s) (i.e., targeted curettage, abrasion) followed with photodynamic therapy by external application of light.

Considering all the new CPT codes for 2018, including the addition of 41 new Category III codes and 17 proprietary laboratory analyses (PLA) codes, healthcare providers must not lose sight of the basic principle of clinical documentation and the establishment of medical necessity for all services provided, charged, coded and billed. In addition, category III codes are

particularly

problematic

in

the

context

of

Medicare

and

other

third-party

reimbursement; just because there is a code, it does not necessarily mean that the code is reimbursable.

The complete listings about the CPT code changes and descriptors are published in the AMA’s CPT 2018 code book. Reliable medical coding services can help healthcare practices better prepare for the 2018 changes.

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