NCHIMA Fall Conference

NCHIMA Fall Conference
2019 CPT Code Changes NCHIMA Fall Conference

Surgery

Fine Needle Aspiration
The area of Fine needle aspiration has been reorganized. First Lesion Each additional lesion Was Imaging used for guidance What type of imaging Ultrasound Fluoroscopic guidance CT Guidance MR Guidance

Fine needle aspiration (FNA): material is aspirated with a fine needle and the cells are examined cytologically Core needle biopsy: performed with a large bore needle to obtain a core sample of tissue for histopathologic evaluation

Imaging procedures may not be reported separately with fine needle aspiration E.g., 76942, 77002, 77012, 77021 Cytologic evaluation may be reported with codes 88172, 88173, 88177

When more than one FNA biopsy is performed on separate lesions at the same session, same day, same imaging modality, use the appropriate imaging modality add-on code for the second and subsequent lesion(s) Modifier 59 is not necessary

When more than one FNA biopsy is performed on separate lesions, same session, same day, using different imaging modalities, report the corresponding primary code with modifier 59 for each additional imaging modality and corresponding add-on codes for subsequent lesions sampled Lesions may be ipsilateral or contralateral to each other Lesions may be in the same or different organs or structures

Fine needle Aspiration
When fine needle aspiration biopsy and core needle biopsy both are performed on the same lesion, same session, same day using the same type of imaging guidance, do not separately report the imaging guidance for the core needle biopsy

When FNA biopsy is performed on one lesion and core needle biopsy is performed on a separate lesion, same session, same day using the same type of imaging guidance, both the core needle biopsy and the imaging guidance for the core needle biopsy may be reported separately with modifier 59

When FNA biopsy is performed on one lesion and core needle biopsy is performed on a separate lesion, same session, same day using different types of imaging guidance, both the core needle biopsy and the imaging guidance for the core needle biopsy may be reported with modifier 59

10004 should be used in conjunction with 10021 10021: Fine needle aspiration biopsy, without imaging guidance; first lesion 10004: each additional lesion

10006 should be used in conjunction with 10005 10005: Fine needle aspiration biopsy, including ultrasound guidance; first lesion 10006: each additional lesion

Use CPT code in conjunction with 10007 10007: fine needle aspiration biopsy, including fluoroscopic guidance; first lesion 10008: each additional lesion

Fine needle aspiration
Use CPT code along with 10009 10009: Fine needle aspiration biopsy, including CT guidance; first lesion 10010: each additional lesion

Use CPT code in conjunction with 10011 10011: Fine needle aspiration biopsy, including MR guidance; first lesion 10012: Each additional lesion

For percutaneous image-guided fluid collection drainage by catheter of soft tissue (e.g., extremity, abdominal wall, neck), use CPT code 10030 For percutaneous needle biopsy other than fine needle aspiration, see – for breast, for muscle, for pleura, for lung or mediastinum, for salivary gland, for liver, for pancreas, for abdominal or retroperitoneal mass, for kidney, for testis, for epididymis, for thyroid, for nucleus pulposus, intervertebral disc, or paravertebral tissue, for spinal cord

Skin Biopsies The category of skin biopsies has been expanded to show the type of biopsy performed Tangential Punch Excisional The use of a biopsy procedure code (e.g., 11102, 11103, 11104, 11105, , 11107) indicates that the procedure to obtain tissue solely for diagnostic histopathologic examination was performed independently or was unrelated or distinct from other procedure/services provided at that time

Skin Biopsies Biopsies performed on different lesions or different sites on the same date of service may be reported separately, as they are not considered components of other procedures During certain surgical procedures in the integumentary system, such as excision, destruction, or shave removals the removed tissue is often submitted for pathologic examination The obtaining of tissue for pathology during the course of these procedures is a routine component of such procedures. Not considered a separate biopsy procedure and is not separately reported.

Skin biopsies Partial-thickness biopsies are those that sample a portion of the thickness of skin or mucous membrane and do not penetrate below the dermis or lamina propria Full-thickness biopsies penetrate into tissue deep to the dermis or lamina propria into the subcutaneous or submucosal space Sampling of stratum corneum only, by any modality (e.g., skin scraping, tape stripping) does not constitute a skin biopsy procedure and is not separately reportable

Tangential biopsy Shave Scoop Saucerize Curette
Performed with a sharp blade, such as a flexible biopsy blade, obliquely oriented scalpel or curette to remove a sample of epidermal tissue with or without portions of underlying dermis The intent of a tangential biopsy (11102, 11103) is to obtain a tissue sample from a lesion for the purpose of diagnostic pathologic examination

Tangential Biopsy A tangential biopsy technique is not considered an excision May be represented by a superficial sample and does not involve the full thickness of the dermis, so lesions technically could remain in the deeper layers of the dermis For therapeutic removal of epidermal or dermal lesion(s) using shave technique, see – 11313 A symptomatic lesion that rubs on waistbands or bras or any other reason why an elevated lesion is being completely removed with the shave technique, suggesting a therapeutic intent It is the responsibility of the physician or qualified health care professional performing the procedure to clearly indicate the purpose of the procedure

Tangential biopsy 11102: Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette; single lesion 11103: Each separate/additional lesion

Punch Biopsy Requires a punch tool to remove a full-thickness cylindrical sample of skin Intent is to obtain a cylindrical tissue sample of a cutaneous lesion for the purpose of diagnostic pathologic examination Simple closure of the defect is included in the service Manipulation of the biopsy defect to improve wound approximation is included in simple closure

Punch biopsy 11104: Punch biopsy of skin (including simple closure, when performed); single lesion 11105; each separate/additional lesion

Incisional Biopsy Requires the use of a sharp blade (not a punch tool) to remove a full- thickness sample of tissue via a vertical incision or wedge, penetrating deep to the dermis, into the subcutaneous space The intent of an incisional biopsy is to obtain a full-thickness tissue sample of a skin lesion for the purpose of diagnostic pathologic examination May sample subcutaneous fat, such as those performed for the evaluation of panniculitis Simple closure is not separately reported

Skin Biopsies Complete lesion excision should be considered an excision, not a biopsy This is reported with – 11646 Margins would be excised as well

Skin biopsies When multiple biopsy techniques are performed during the same encounter, only one primary lesion biopsy code (11102, 11104, 11106) is reported Additional biopsy codes should be selected based on the following convention If multiple biopsies of the same type are performed, the primary code for that biopsy should be used along with the corresponding add-on code(s) If an incisional biopsy is performed, report 1110 in combination with a tangential (11103), punch (11105), or incisional biopsy (11107) for the additional biopsy procedures

Skin biopsies If a punch biopsy is performed, report in combination with a tangential (11103), or punch (11105), for the additional biopsy procedures If multiple tangential biopsies are performed, report tangential biopsy (11102) in combination with for the additional tangential biopsy procedures When two or more biopsies of the same technique (i.e., tangential, punch, or incisional) are performed on separate/additional lesions, use the appropriate add-on code (11103, 11105, 11107) to specify each additional biopsy.

Skin Biopsies When two or three different biopsy techniques (i.e., tangential, punch, or incisional) are performed to sample separate/additional lesions, select the appropriate biopsy code (11102, 11104, 11106) plus an additional add-on code (11103, 11105, 11107) for each additional biopsy performed Hierarchy: Incisional Punch Tangential

Skin Biopsy CPT code may be used in conjunction with 11102, 11104, and when different biopsy techniques are performed to sample separate/additional lesions for each type of biopsy technique used CPT code may be used in conjunction with 11104, when different biopsy techniques are performed to sample separate/additional lesions for each type of biopsy technique used CPT code my be used in conjunction with 11106

Incision and Drainage of Soft Tissue Abscess
CPT Code has been deleted For incision and drainage of subfascial soft tissue abscess, see appropriate incision and drainage for specific anatomic sites

Musculoskeletal Grafts
Three new codes were added into the Graft section 20932: Allograft, includes templating, cutting, placement, and internal fixation, when performed; osteoarticular, including articular surface and contiguous bone Add-on code Do not report in conjunction with 20933, 20934, 23200, 24152, 27078, 27090, 27081, 27448, , 27647, 27648

Musculoskeletal Grafts
20933: Hemicortical intercalary, partial (i.e., hemicylindrical) Add-on code Do not report in conjunction with20932, 20934, 23200, 24152, 27078, 27090,27091, , 27646,27647, 27648 20934: Intercalary, complete (i.e., cylindrical) Do not report in conjunction with 20832,20933,20955, 20956, 20957, 20962, 23146, , 23200, 24116, 24126, 24152, 25125, 25135, 27078, 27090, 27091, 27130, 27132, , 27138, , 27244, 27356, 27448, 27638, 27646, 27547, 27648, 28103, 28107

Injection procedure for knee arthrogram
Code 27370: Injection of contrast for knee arthrography has been deleted Code 27369: injection procedure for contrast knee arthrography or contrast enhanced CT/MRI knee arthrography is new and takes the place of 27370 Use in conjunction with 73580, 73701, 73702, 73722, 73723 Do not report in conjunction with 20610, 20611, 29871 For arthrocentesis of the knee or injection of any material other than contrast for subsequent arthrography, see 20610, 20611 When fluoroscopic guided injection is performed for enhanced CT arthrography, use 27369, 77002, and or 73702

Injection procedure for knee arthrogram
When fluoroscopic guided injection is performed for enhanced MR arthrography, use 27369, 77002, and or 73723 For arthroscopic lavage and drainage of the knee, use 29871 For radiographic arthrography, radiological supervision and interpretation, use 73580 For arthrocentesis of the knee or injection of any material other than contrast for subsequent arthrography, see 20610, 20611 For injection procedure for contrast knee arthrography or contrast enhanced CT/MRI knee arthrography, use 27369

Section Laryngeal Nerve
CPT Code has been deleted 31595: Section recurrent laryngeal nerve, therapeutic (separate procedure) , unilateral Larynx < Nerve< section No replacement code

Leadless Pacemaker

Leadless Pacemaker 33274: Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (e.g., fluoroscopy, venous ultrasound, ventriculography, femoral venography, and device evaluation (e.g., interrogation or programming), when performed 33275: Transcatheter removal of permanent leadless pacemaker, right ventricular Do not report in conjunction with 33275 Do not report 33274, in conjunction with femoral venography (75820), fluoroscopy (76000, 77002), ultrasound guidance for vascular access (76937), right ventriculography (93566)

Leadless Pacemaker Do not report 33274, in conjunction with 93451, 93453, 9356, 93457, , 93461, 93530, 93531, 93532, 93533, unless complete right heart catheterization is performed for indications distinct from the leadless pacemaker procedure For subsequent leadless pacemaker device evaluation see 93279, 93286, , 93294, 93296

Cardiac Event Recorder
A subcutaneous cardiac rhythm monitor, also known as a cardiac event recorder or implantable/insertable loop recorder (ILR), is a subcutaneously placed device that continuously records the electrocardiographic rhythm, triggered automatically by rapid, irregular and/or slow heart rates or by the patient during a symptomatic episode. A subcutaneous cardiac rhythm monitor is placed using a small parasternal incision followed by insertion of the monitor into a small subcutaneous prepectoral pocket, followed by closure of the incision

Cardiac Event Recorder
33282: Implantation of patient-activated cardiac event recorder DELETED Use 33285: Insertion, subcutaneous cardiac rhythm monitor, including programming For subsequent 33284: Removal of an implantable, patient-activated cardiac event recorder DELETED Use 33286: Removal, subcutaneous cardiac rhythm monitor

Implantable Hemodynamic Monitors
Transcatheter implantation of a wireless pulmonary artery pressure sensor establishes an intravascular device used for long-term remote monitoring of pulmonary artery pressures. The hemodynamic data derived from this device is used to guide management of patients with heart failure Includes deployment and calibration of the sensor, right heart catheterization, selective pulmonary artery catheterization, radiological supervision and interpretation, and pulmonary artery angiography, when performed.

Implantable Hemodynamic Monitors
33289: Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring, including deployment and calibration of the sensor, right heart catheterization, selective pulmonary catheterization, radiological supervision and interpretation, and pulmonary artery angiography, when performed For remote monitoring of an implantable wireless pulmonary artery pressure sensor, use 93264

Ross-Konno Inpatient only Ross-Konno procedure
Replacement, aortic valve; by translocation of autologous pulmonary valve and transventricular aortic annulus enlargement of the left ventricular outflow tract with valved conduit replacement of pulmonary valve

Aortic Anastomosis Inpatient only:
Aortic hemiarch graft including isolation and control of the arch vessels, beveled open distal aortic anastomosis extending under one or more of the arch vessels, and total circulatory arrest or isolated cerebral perfusion

PICC Lines Verbiage change for 36568, 36569:
2018: Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; younger than 5 years of age 2019: Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age 36569: greater than 5 years of age

PICC Lines New codes – with/without imaging guidance
Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than 5 years of age 36573: age 5 years or older

PICC Lines Verbiage change for 36584
2018: : Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access 2019: Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the replacement

Lymph Node Biopsy 38531: Biopsy or excision of lymph node(s); open inguinofemoral node(s) New code Unilateral code; for bilateral procedure(s), report with modifier 50

Fixation of tongue 41500: Fixation of tongue, mechanical, other than suture has been deleted

Replacement of Gastrostomy Tube
43760: Change of gastrostomy tube, percutaneous has been deleted. To report replacement of gastrostomy tube without imaging or endoscopy, see 43762, 43763

Sphincteroplasty 46762: Sphincteroplasty, anal, for incontinence or prolapse; implantation artificial sphincter has been deleted For anoscopy with directed submucosal injection of bulking agent for fecal incontinence, use 3077T

Establishing Nephrostomy Tract
50395: Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous has been DELETED. To report, see 50436, 50437 50436: Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedural tube placement, when performed; 50437 including new access into the renal collecting system

Other Prostatic Procedures
53854: Transurethral destruction of prostate tissue; by radiofrequency generated water vapor thermotherapy

Exploration of orbit CPT code Exploration of orbit (transcranial approach); with biopsy has been DELETED CPT code Exploration of orbit (transcranial approach)with removal of lesion has been retained.

Craniectomy CPT code 61480: Craniectomy, suboccipital: for mesencephalic tractotomy or pedunculotomy has been DELETED

Transection Carotid Artery
CPT code 61610: Transection or ligation, carotid artery in cavernous sinus, with repair by anastomosis or graft has been DELETED CPT code Transection or ligation, carotid artery in petrous canal; with repair by anastomosis or graft has been DELETED

Balloon Dilatation of Intracranial Vasospasm
Verbiage changed for 61641 2018: Balloon dilatation of intracranial vasospasm, percutaneous; each additional vessel in same vascular family 2019: Balloon dilatation of intracranial vasospasm, percutaneous; each additional vessel in same vascular territory Verbiage changed for 61642 2018: Balloon dilatation of intracranial vasospasm, percutaneous; each additional vessel in different vascular family 2019: Balloon dilatation of intracranial vasospasm, percutaneous; each additional vessel in different vascular territory

Stereotaxis CPT Code Stereotactic biopsy, aspiration, or excision of lesion, spinal cord has been DELETED

Injections Autonomic Nerves
CPT code 64508: Injection, anesthetic agent; carotid sinus has been DELETED

TENS CPT code 64550: Application of surface (transcutaneous) neurostimulator (e.g., TENS unit) has been DELETED To report a transcutaneous nerve stimulation (TENS), use for electrical stimulation requiring supervision only or use for electrical stimulation requiring constant attendance

Scleral Staphyloma CPT code 66220: Repair of scleral staphyloma; without graft has been DELETED CPT code Repair of scleral staphyloma with graft remains

Evaluation and Management

Interprofessional Telephone/Internet Consultations
Verbiage changed in codes – 99449 2018: 99446: Interprofessional telephone/internet assessment and management service provided b a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; minutes of medical consultative discussion and review 99447: 11 – 20 minutes of medical consultative discussion and review 99448: 21 – 30 minutes of medical consultative discussion and review 99449: 31 minutes or more of medical consultative discussion and review

Verbiage changed in codes – 99449 2019: 99446: Interprofessional telephone/internet/electronic health record assessment and management service provided b a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review 99447: 11 – 20 minutes of medical consultative discussion and review 99448: 21 – 30 minutes of medical consultative discussion and review 99449: 31 minutes or more of medical consultative discussion and review

New Codes 99451: Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time 99452: Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes This code is to be used if spending minutes in a service day preparing for the referral and/or communicating with the consultant May only be reported once every 14 days

Digitally Stored Data Services/ Remote Physiologic Monitoring
Codes and are used to report remote physiologic monitoring services, such as weight, blood pressure, pulse oximetry , during a 30-day period. There must be an order and the device used must be defined by the FDA as a medical device Monitoring must be at least 16 days

99453: Remote monitoring of physiologic parameter(s), (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment May be used to report the setup and patient education on the use of the device(s) Reported for each episode of care Episode of care: beginning when the remote monitoring physiologic service is initiated, and ends with attainment of targeted treatment goals

99454: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording() or programmed alert(s) transmission, each 30 days May be used to report supply of the device for the daily recording or programmed alert transmissions

Verbiage changed Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days May be reported once in a 30-day period to include the physician or other qualified health care professional time involved with data accession, review, and interpretation, modification of the care plan as necessary (including communication to patient and/or caregiver), and associated documentation

Remote Physiologic Monitoring Treatment Management Services
99457: Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month Report once each 30 days, regardless of the number of parameters monitored Do not report in conjunction with 99091 Use for time spent managing care when patients or the practice do not meet the requirement to report more specific services

99491 99491: Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month with the following required elements: Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline Comprehensive care plan established, implemented, revised or monitored 99490 current and previous code – at least 20 minutes

Medicine

Influenza vaccine New code
90689: Influenza virus vaccine, quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use

Other Specialized Services
92275: Electroretinography with interpretation and report has been DELETED Report with 92273, 92274, 0509T 92273: Electroretinography (ERG), with interpretation and report; full field (i.e., ffERG, flash ERG, Ganzfeld ERG) 92274: Electroretinography (ERG), with interpretation and report; multifocal (mfERG) 0509T: Electroretinography (ERG) with interpretation and report, pattern (PERG)

Implantable, Insertable, and Wearable Cardiac Device Evaluations
93264: Remote monitoring of a wireless pulmonary artery pressure sensor for up to 30 days, including at least weekly downloads of pulmonary artery pressure recording, interpretation(s), trend analysis, and report(s) by a physician or other qualified health care professional

Verbiage changed for code 93279 2018: Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified healthcare professional; single lead pacemaker system 2019: Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified healthcare professional; single lead pacemaker system, or leadless pacemaker system

Verbiage change for 93285 2018: Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified healthcare professional; implantable loop recorder system 2019: Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified healthcare professional; subcutaneous cardiac rhythm monitor system

Verbiage change for 93286 2018: Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review, and report by a physician or other qualified health care professional, single, dual, or multiple lead pacemaker system 2019: Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review, and report by a physician or other qualified health care professional, single, dual, or multiple lead pacemaker system, or leadless pacemaker system

Verbiage change for 93288 2018: Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording, and disconnection per patient encounter; single, dual, or multiple lead pacemaker system 2019: Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording, and disconnection per patient encounter; single, dual, or multiple lead pacemaker system, or leadless pacemaker system

Verbiage change for 93290 2018: Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording, and disconnection per patient encounter; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors 2019: Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording, and disconnection per patient encounter; implantable cardiovascular physiologic monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors

Verbiage change for 93291 2018: Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording, and disconnection per patient encounter; implantable loop recorder system, including heart rhythm derived data analysis 2019: Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording, and disconnection per patient encounter; subcutaneous cardiac rhythm monitor system, including heart rhythm derived data analysis

Verbiage change for 93294 2018: Interrogation device evaluation(s)(remote), up to 90 days; single, dual, or multiple lead pacemaker system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional 2019: Interrogation device evaluation(s)(remote), up to 90 days; single, dual, or multiple lead pacemaker system, or leadless pacemaker system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional

Verbiage change for 93296 2018: Interrogation device evaluation(s)(remote), up to 90 days; single, dual, or multiple lead pacemaker system or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results 2019: Interrogation device evaluation(s)(remote), up to 90 days; single, dual, or multiple lead pacemaker system, leadless pacemaker system, or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

Verbiage change for 93297 2018: Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors, analysis, review(s) and report(s) by a physician or other qualified health care professional 2019: Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors, analysis, review(s) and report(s) by a physician or other qualified health care professional

Verbiage change for 93298 2018: Interrogation device evaluation(s), (remote) up to 30 days; implantable loop recorder system, including analysis of recorded heart rhythm data, analysis, review(s) and report(s) by a physician or other qualified health care professional 2019: Interrogation device evaluation(s), (remote) up to 30 days; subcutaneous cardiac rhythm monitor system, including analysis of recorded heart rhythm data, analysis, review(s) and report(s) by a physician or other qualified health care professional

Verbiage change for 93299 2018: Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system or implantable loop recorder system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results 2019: Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

Car Seat Testing Verbiage change for 94780 and 94781
2018: Car seat/bed testing for airway integrity, neonate, with continual nursing observation and continuous recording of pulse oximetry, heart rate and respiratory rate, with interpretation and report; 60 minutes 2019: Car seat/bed testing for airway integrity, for infants through 12 months of age, with continual clinical staff observation and continuous recording of pulse oximetry, heart rate and respiratory rate, with interpretation and report; 60 minutes 904781: each additional full 30 minutes

Electrocorticography
95836: new code: Electrocorticogram from an implanted brain neurostimulator pulse generator/transmitter, including recording, with interpretation and written report, up to 30 days

Neurostimulators 95976: Electronic analysis of implanted neurostimulator pulse generator/transmitter by physician or other qualified health care professional; with simple cranial nerve neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional 95977: Electronic analysis of implanted neurostimulator pulse generator/transmitter by physician or other qualified health care professional; with complex cranial nerve neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional

Neurostimulators 95983: Electronic analysis of implanted neurostimulator pulse generator/transmitter by physician or other qualified health care professional; with brain neurostimulator pulse generator/transmitter programming, first 15 minutes face-to-face time with physician or other qualified health care professional 95984: Electronic analysis of implanted neurostimulator pulse generator/transmitter by physician or other qualified health care professional; with brain neurostimulator pulse generator/transmitter programming, each additional 15 minutes face-to-face time with physician or other qualified health care professional

Adaptive Behavior Assessments
May include analysis of pertinent past data (including medical diagnosis), a detailed behavioral history, patient observation, administration of standardized and/or nonstandardized instruments and procedures, functional behavior assessment, functional analysis, and/or guardian/caregiver interview to identify and describe problematic behaviors 97151: Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician’s or other qualified health care professional’s time face-to-face with patient and/or guardian(s) caregiver(s) administering assessments and discussing findings and recommendations and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan

Adaptive Behavior Assessments
97152: Behavior identification –supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes Administered by a tech under the direction of a physician or other qualified health care professional Includes the interpretation of results and may include functional behavior assessment, functional analysis, and other structured observations and/or standardized and/or nonstandardized instruments and procedures

Adaptive Behavior Treatment
Describe services that address specific treatment targets and goals based on results of previous assessment and include ongoing assessment as well as adjustment of treatment protocols, targets, and goals Items the codes are looking for: Protocol Protocol modification Face-to-face time On site/Not on site Number of technicians Deficient behaviors/Destructive behaviors Customized environment

97153: Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes 97154: Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes Do not report if the group has more than 8 patients

97155: Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes 97156: Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes

97157: Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, each 15 minutes Do not report if the group has more than 8 families 97158: Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face- to-face with multiple patients, each 15 minutes Do not report if the group has more than 8 patients

Central Nervous System Assessments
96101: Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, e.g., MMPI, Rorschach, WAIS), per hour of the psychologist’s or physician’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report has been DELETED 96102: Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, e.g., MMPI, Rorschach, WAIS), with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face has been DELETED

Central Nervous System Assessments
96103: Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, e.g., MMPI), administered by a computer, with qualified health care professional interpretation and report has been DELETED To report psychological testing evaluation and administration and scoring services, see 96130, , 96137, 96138, 96139, 96146)

Developmental/Behavioral Screening and Testing
96111: Developmental testing, (includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments) with interpretation and report has been DELETED Report with and 96113 96112: Developmental test administration including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour 96113: each additional 30 minutes

Neurobehavioral Status Examination
Verbiage Changed for CPT code 96116 2018: Neurobehavioral status exam (clinical assessment of thinking, reasoning, and judgment, e.g., acquired knowledge, attention, language, memory, planning, and problem solving, and visual spatial abilities), per hour of the psychologist’s or physician’s time, both face-to-face time with the patient and time interpreting test results and preparing the report 2019: Neurobehavioral status examination (clinical assessment of thinking, reasoning, and judgment, e.g., acquired knowledge, attention, language, memory, planning, and problem solving, and visual spatial abilities), by physician or other qualified health care professional, per hour of the psychologist’s or physician’s time, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour

96121: Neurobehavioral status examination (clinical assessment of thinking, reasoning, and judgment, e.g., acquired knowledge, attention, language, memory, planning, and problem solving, and visual spatial abilities), by physician or other qualified health care professional, per hour of the psychologist’s or physician’s time, both face-to-face time with the patient and time interpreting test results and preparing the report; each additional hour New code

96118: Neuropsychological testing(e.g., Halstead-Reitan Neuropsychological Battery, Wechsler memory Scales and Wisconsin Card Sorting Test), per hour of the psychologist’s or physician’s time, both face- to-face time administering tests to the patient and time interpreting these test results and preparing the report has been DELETED 96119: Neuropsychological testing(e.g., Halstead-Reitan Neuropsychological Battery, Wechsler memory Scales and Wisconsin Card Sorting Test), with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to- face has been DELETED

96120: neuropsychological testing (e.g., Wisconsin Card Sorting Test), administered by a computer, with qualified health care professional interpretation and report has been DELETED To report neuropsychological testing evaluation and administration and scoring services (codes – 96120), see 96132, 96133, 96136, 96137, , 96139, and 96146)

Testing Evaluation Services
New Codes 96130; Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour 96131: Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; each additional hour

Testing Evaluation Services
New Codes 96132: Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour 96133: Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; each additional hour

Test Administration and Scoring
New codes 96136: Psychological or neuropsychological test administration and scoring by physician or other qualified healthcare professional, two or more tests, any method; first 30 minutes 96137: Psychological or neuropsychological test administration and scoring by physician or other qualified healthcare professional, two or more tests, any method; each additional 30 minutes

Test Administration and Scoring
New Codes 96138: Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes 96139: Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; each additional 30 minutes

Automated Testing and Results
96146: Psychological or neuropsychological test administration, with single automated, standardized instrument via electronic platform, with automated result only

Miscellaneous Services
99090: analysis of clinical data stored in computers (e.g., ECGs, Blood pressures, hematologic data has been DELETED Report more specific CPT codes when available 93227, 93272, 0206T for cardiographic services 92950 for continuous glucose monitoring 97750 for musculoskeletal function testing

New Technology

Drug eluting implant in the ethmoid sinus
Deleted codes 0406T: Nasal endoscopy, surgical, ethmoid sinus, placement of drug eluting implant; Report with 31299 0407T: Nasal endoscopy, surgical, ethmoid sinus, placement of drug eluting implant; with biopsy, polypectomy or debridement Report with 31237

Computer-aided breast detection MRI
Deleted: 0159T: Computer-aided detection, including computer algorithm analysis of MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation, breast MRI To report, see 77048, 77049 77048: Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral 77049: bilateral

Remote Video-conferenced Critical Care Services
Deleted 0188T: Remote real-time interactive video-conferenced critical care, evaluation and management of the critically ill or critically injured patient; first 30 – 74 minutes Use 99499 Deleted 0189T: Remote real-time interactive video-conferenced critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes

Placement of intraocular radiation source applicator
Deleted 0190T: Placement of intraocular radiation source applicator Use 67299 For application of the source by radiation oncologist, see Clinical Brachytherapy section

Presacral Interbody Technique L5-S1 Arthrodesis
Deleted 0195T: Arthrodesis, pre-sacral interbody technique, disc space preparation, discectomy, without instrumentation , with image guidance, includes bone graft when performed; L5-S1 interspace Use 22899 Deleted 0196T: L4-L5 interspace

Subtalar Joint implant
Code 0335T has been revised 2018: Extra-osseous subtalar joint implant for talotarsal stabilization 2019: insertion of sinus tarsi implant New Codes 0510T: Removal of sinus tarsi implant 0511T: Removal and reinsertion of sinus tarsi implant

Endothelial Function Assessment
Deleted Code 0337T: Endothelial function assessment, using peripheral vascular response to reactive hyperemia, non-invasive (e.g., brachial artery ultrasound, peripheral artery tonometry), unilateral or bilateral Use 93998

Ultrasound, elastography
Deleted Code 0346T: Ultrasound, elastography To report see 76981, 76982, 76983 76981: Ultrasound, elastography; parenchyma (e.g., organ) 76982: first target lesion 76983: each additional target lesion For evaluation of a parenchymal organ and lesion(s) in the same parenchymal organ at the same session, report only 76981 Do not report more than two times per organ

Adaptive Behavior Assessments and Treatment
Deleted 0359T: Behavior identification assessment, by the physician or other qualified health care professional, face-to face… Deleted 0360T: Observational behavioral follow-up assessment… Deleted 0361T: each additional 30 minutes of technician time, face-to – face with the patient Use 97151, 97152

0363T- 0372T To report, see 97153, 97154, 97155, 97156, 97157, 97158, 0373T Codes have been deleted and are under Adaptive Treatment Behaviors

Adaptive Behavior Assessment
Modified Code 0362T Behavior Identification Supporting Assessment, each 15 minutes of technicians’ time face-to-face with a patient, requiring the following components: Administration by the physician or other qualified health care professional who is on site With the assistance of two or more technicians For a patient who exhibits destructive behavior Completion in an environment that is customized to the patient’s behavior

Modified Code 0373T: Adaptive behavior treatment with protocol modification, each 15 minutes of technicians’ time face-to-face with a patient, requiring the following components: Administration by the physician or other qualified health care professional who is on site With the assistance of two or more technicians For a patient who exhibits destructive behavior Completion in an environment that is customized to the patient’s behavior

Wireless Cardiac Stimulation System for Left Ventricular Pacing
A wireless cardiac stimulator system provides biventricular pacing by sensing right ventricular pacing output from a previously implanted conventional device and then transmits an ultrasound pulse to a wireless electrode implanted on the endocardium of the left ventricle, which then emits a left ventricular pacing pulse Must have a previously implanted conventional device Pacemaker or defibrillator with univentricular or biventricular leads

The complete system consists of two components: a wireless endocardial left ventricle electrode and a pulse generator The pulse generator has two components: a transmitter and a battery The electrode is implanted transarteriall into the left ventricular wall and powered wirelessly using ultrasound delivered by a subcutaneously implanted transmitter Two subcutaneous pockets are created on the chest wall, one for the battery and one for the transmitter, and these two components are connected by a subcutaneously tunneled cable

Patients with a wireless cardiac stimulator require programming/interrogation of their existing conventional device, as well as the wireless device The wireless cardiac stimulator is programmed and interrogated with its own separate programmer and settings

All catheterization and imaging guidance (including transthoracic or transesophageal echocardiography) required to complete a wireless cardiac stimulator procedure is included in 0515T – 0520T Do NOT report 76000, 76998, – in conjunction with 0515T – 0520T Do NOT report left heart catheterization codes (93452, 93453, 93458, 93459, , 93461, 93531, 93532, 93533) for delivery of a wireless cardiac stimulator electrode into the left ventricle

0515T 0515T : Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming and imaging supervision and interpretation, when performed; complete system (includes electrode and generator [transmitter and battery]) 0516T: Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming and imaging supervision and interpretation, when performed; electrode only 0517T: Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming and imaging supervision and interpretation, when performed; pulse generator component(s) (battery and/or transmitter) only

0518T 0518T: Removal of only pulse generator component(s) (battery and/or transmitter) of wireless cardiac stimulator for left ventricular pacing 0519T: Removal and replacement of wireless cardiac stimulator for left ventricular pacing; pulse generator component(s) (battery and/or transmitter) 0520T: Removal and replacement of wireless cardiac stimulator for left ventricular pacing; pulse generator component(s) (battery and/or transmitter), including placement of a new electrode

0521T 0521T: Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording, and disconnection per patient encounter, wireless cardiac stimulator for left ventricular pacing 0522T: Programming device evaluation j(in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, including review and report, wireless cardiac stimulator for left ventricular pacing 0524T: Endovenous catheter directed chemical ablation with balloon isolation of incompetent extremity vein, open or percutaneous, including all vascular access, catheter manipulation, diagnostic imaging, imaging guidance and monitoring

0525T 0525T: Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpretation; complete system (electrode and implantable monitor) 0526T: Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpretation; electrode only 0527T: Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpretation; implantable monitor only

0528T 0528T: Programming device evaluation (in person) in intracardiac ischemia monitoring system with iterative adjustment of programmed values, with analysis, review, and report 0529T: Interrogation device evaluation (in person) of intracardiac, ischemia monitoring system with analysis, review, and report

0532T 0530T: Removal of intracardiac ischemia monitoring system, including all imaging supervision and interpretation; complete system (electrode and implantable monitor) 0531T: Removal of intracardiac ischemia monitoring system, including all imaging supervision and interpretation; electrode only 0532T: Removal of intracardiac ischemia monitoring system, including all imaging supervision and interpretation; implantable monitor only

0533T 0533T: Continuous recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor for 6 days up to 10 days; includes setup, patient training, configuration of monitor, data upload, analysis and initial report configuration, download review, interpretation and report 0534T : Continuous recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor for 6 days up to 10 days; set up, patient training, configuration of monitor 0535T: Continuous recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor for 6 days up to 10 days; data upload, analysis, and initial report configuration 0536T: Continuous recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor for 6 days up to 10 days; download review, interpretation and report

Cellular and Gene Therapy
Cellular and gene therapies involve the collection, processing, and handling of cells or other tissues, genetic modification of those cells or tissues, and administration of the genetically modified cells or tissues with the intent to treat, modify, reverse, or cure a serious or life-threatening disease or condition The development of genetically modified cells is not reported with this family of codes

Chimeric antigen receptor therapy (CAR-T) with genetically modified T cells begins with the collection of cells from the patient by peripheral blood leukocyte cell harvesting The cells are then cryopreserved and/or otherwise prepared for processing or shipping to a manufacturing or cell processing facility, if applicable, where gene modification and expansion of the cells is performed When gene modification and expansion of the cells by the manufacturer is complete, the genetically modified cells are returned to the physician or other qualified health care professional in which additional preparation occurs, including thawing of the cryopreserved CAR-T cells, if necessary, before the cells are administered to the patient

The procedure to administer CAR-T cells includes physician monitoring of multiple physiologic parameters, physician verification of cell processing , evaluation of the patient during, as well as immediately before and after the administration of the CAR-T cells, physician presence during the administration and direct supervision of clinical staff, and management of any adverse events during the administration

Care on the same date of service that is not directly related to the service of administration of the CAR-T cells may be separately reported using the appropriate evaluation and management code with modifier -25 Management of uncomplicated adverse events (e.g., nausea, urticaria) during the infusion is not separately reportable Care provided after the administration is complete may be separately reportable Care for the patient’s underlying condition may be separately reportable Other medical problems may be separately reportable

The fluid used to administer the cells and other infusions for incidental hydration (96360 and 96361) are not reported separately Infusions of any supportive medications, such as steroids, concurrently with the CAR-T cell administration are not reported separately Hydrations or administrations of medications unrelated to the CAR-T administration may be reported separately with modifier 59

0537T May be reported only once per day
0537T: Chimeric antigen receptor T-cell (CAR-T) therapy; harvesting of blood-derived T lymphocytes for development of genetically modified autologous CAR-T cells, per day 0538T: Chimeric antigen receptor T-cell (CAR-T) therapy; preparation of blood-derived T lymphocytes for transportation (e.g., cryopreservation, storage) 0539T: Chimeric antigen receptor T-cell (CAR-T) therapy; receipt and preparation of CAR-T cells for administration

0540T May be reported only once per day
0540T: Chimeric antigen receptor T-cell (CAR-T) therapy; CAR-T cell administration, autologous 0541T: Myocardial imaging by magnetocardiography(MCG) for detection of cardiac ischemia, by signal acquisition using minimum 36 channel grid, generation of magnetic-field time-series images, quantitative analysis of magnetic dipoles, machine learning-derived clinical scoring, and automated report generation, single study;

0541T 0541T: Myocardial imaging by magnetocardiography(MCG) for detection of cardiac ischemia, by signal acquisition using minimum 36 channel grid, generation of magnetic-field time-series images, quantitative analysis of magnetic dipoles, machine learning-derived clinical scoring, and automated report generation, single study; 0542T: Myocardial imaging by magnetocardiography(MCG) for detection of cardiac ischemia, by signal acquisition using minimum 36 channel grid, generation of magnetic-field time-series images, quantitative analysis of magnetic dipoles, machine learning-derived clinical scoring, and automated report generation, single study; interpretation and report

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