The American Medical Association (AMA) released new current procedural terminology (CPT®) codes during its 2018 CPT and RBRVS symposium held in Chicago Nov. 15-17.

Significant changes to the 2018 CPT® codes and descriptors were announced late last week by the American Medical Association (AMA), including 170 new CPT codes, 60 revised codes, and 82 deleted codes, amounting to a total of 312 edits in CPT for 2018 and a total of 10,155 code sets. In addition, there are two newly created modifiers for use in 2018. The breakdown of new CPT codes is as follows:

Sections Added Revised Deleted
E & M 5 4 2
Surgery 42  24  19 
Radiology  18 
Path/Lab  40  17  12 
Medicine 13  10 
Category II 
Category III  41  22 
PLA Codes  17 
Totals 170  60  82 

The two new modifiers were created to identify services as habilitative or rehabilitative, as follows (appearing in the 2018 CPT Book):

  • Modifier 96- Habilitative Services: When a service or procedure that may either be habilitative in nature or rehabilitative in nature is provided for habilitative purposes, the physician or other qualified healthcare professional may add modifier 96- to the service or procedure code to indicate that the service or procedure provided was habilitative. Such services help an individual learn skills and functioning for daily living that the individual has not yet developed, and then keep or improve those learned skills. Habilitative services also 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 or other qualified healthcare professional may add modifier 97- to the service or procedure code to indicate that the service or procedure provided was rehabilitative. Rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled.

These two modifiers are intended to be reported with services that are identified as being either habilitative or rehabilitative in nature, such as physical medicine and rehabilitation codes, allowing the payer the ability to differentiate habilitative from rehabilitative services. This differentiation is required by the Patient Protection and Affordable Care Act (PPACA).

Other pertinent CPT changes worth noting include the following:

  • Evaluation and Management (E&M) Codes
    • Three new codes for psychiatric collaborative care management services
    • One new code for general behavioral health integration care service
    • 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
    • Creation of two new upper gastrointestinal endoscopic procedure anesthesia codes and deletion of one code
    • Creation of three new lower and upper/lower intestinal endoscopic procedure anesthesia codes and deletion of one code
    • Deletion of two obturator neurectomy anesthesia codes
    • Deletion of one code for anesthesia for shoulder spica case application

There were numerous questions from the audience on appropriate use of new anesthesia code 00812, Anesthesia for lower intestinal endoscopic procedures, endoscopic introduced distal to the duodenum; and screening colonoscopy (report 00812 to describe anesthesia for any screening colonoscopy regardless of ultimate findings). These questions centered on the appropriateness of assigning this new code at the direction of the instructional note, regardless of ultimate finding when the procedure is converted to a diagnostic if a procedure such as polyp removal is performed. The concern was how third-party payers would respond to the assignment of the anesthesia code from a reimbursement perspective when this code was assigned in conjunction with a diagnostic CPT procedure code. The general consensus was that one must be content with a wait-and-see attitude regarding how the payers will react to such a code assignment.

The surgery and radiology codes contain some interesting updates and changes. Let’s start with the surgery section. There are 16 new codes, or five revised and 13 deleted codes in the endovascular section of the CPT code book. These new codes pertain to endovascular repair of abdominal aorta and/or Iliac arteries with an emphasis upon repair using endografts, extension prosthesis, and concepts of delayed placement of prosthesis for endovascular repair of vessels. Coding of these procedures is now determined and guided by “treatment zone” rather than the “targeted treatment zone.” As defined by Katharine Krol, MD, FSIR, FACR, in her excellent presentation at the symposium covering interventional radiology (IR), in targeted treatment zones, endograft services were previously defined by the intended portion(s) of vessel where the endograft was supposed to be placed (target treatment zone).

Anything 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 limb(s), and extension(s) deployed during an operative session. The treatment zone includes all vessel(s) that are treated by the endograft. The speaker pointed out what is bundled as opposed to separately reported in the performance of the endovascular repair of the abdominal aorta and/or Iliac arteries. Many of the associated services performed are bundled, and close attention to avoid unbundling and invoking of the NCCI edits is in order to avoid improper charging, coding, and billing for these services.

Under diagnostic radiology, there are four new codes for chest X-rays, accompanied by nine deletions associated with chest X-rays being categorized by the number of views (single through four or more reviews, as opposed to type of view). The new chest X-ray codes are 71045-71048. Hopefully, this will avoid any confusion in code assignment moving forward. In the abdominal X-ray section, three codes have been deleted and three replacements introduced, 74018-74021, which follow the same principle in the new chest X-ray codes (that is, reporting by the number of views taken versus type of view).

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. There are two new codes in the neurorrhaphy with nerve graft, vein graft, or conduit section of the CPT book, codes 64912 and 64913, to facilitate and allow reporting of nerve pedicle transfer with nerve allograft of each nerve and the add-on code, 64913, with nerve allograft, each additional strand.

On Friday morning, Scott Collins, MD, FAAD, FACMS, covered in great detail and engaged the audience regarding the one revised Category I code and two new Category I codes for photodynamic therapy, two new Category III codes for optical coherence tomography of skin, and two new Category III codes for ablative treatment of burn scars. Dr. Collins outlined in clear detail what photodynamic therapy is, indications for this therapy, and clinical examples of how it works.

Photodynamic therapy is a Food and Drug Administration- (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 has been established to report photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa, with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified healthcare professional, per day. The service represented in this code is 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.

There was an interesting point made by the Medicare carrier medical directors who were in attendance to provide insight, guidance, and answers to questions from attendees on the new CPT codes as well as to conduct a Q&A session to conclude the symposium. In light of all the new CPT codes for 2018, including the addition of 41 new Category III codes and 17 proprietary laboratory analyses (PLA) codes, providers must not lose sight of the overarching principle of clinical documentation and the establishment of medical necessity for all services provided, charged, coded, and billed.

Category III codes are particularly problematic in the context of Medicare and other third-party payer reimbursement; just because there is a code does not necessarily mean the code is reimbursable. In a previous position, I was tasked with updating and maintaining a three-hospital health system chargemaster, so I know and recognize firsthand the importance and urgency to update the chargemaster with all of the new and deleted codes every year prior to Jan. 1 and to educate clinicians and other staff members on the new codes and how to use them.

Another element that must be considered as revenue cycle professionals is informing clinicians of the clinical documentation requirements necessary to establish medical necessity in support of these new CPT codes, as well as for all other provisions of care provided, charged, coded, and billed. I am convinced that the crucial piece of medical necessity often is lost in the shuffle of work done in preparation for the new and deleted CPT codes beginning the first of January each year.

Overall, this was another informative, well-organized AMA CPT Symposium this year. If you have never attended the meeting, I encourage you to attend next year.

Resource Note: Register to attend the the ICD10monitor four-part E&M series featuring Deborah Grider.

Share This Article