For 2020, the American Medical Association (AMA) announced 394 code changes: 248 new codes, 71 deletions, and 75 revisions effective 1/1/2020.
Being aware of code changes is essential to effective revenue management. It is also essential to review your payer contracts to confirm how they may be impacted.
- For example, if you have a carve-out code in your contract and that code is deleted, you may need to contact your payer contract representative to discuss an amendment to your contract.
- Don’t assume that a payer will recognize the coding change and automatically update your contract. Be proactive.
Top code changes:
- Telehealth is becoming a more popular option for patient care, and it is refreshing to see codes added to support this service. There are three time-based codes: 99421, 99422, and 99423, created for online digital E/M services. 99444 was deleted.
- Blood pressure measuring (self-measured) – two codes added to address patients’ access to care and reporting into their physician.
- New codes for behavior assessment and intervention services.
- Enhanced codes for reporting long-term EEG monitoring services.
- Modifier 50 and 63 changes.
Changes by Specialty:
Evaluation and Management:
- Time-based codes for online digital services.
- Service initiated by the patient.
- Guidelines established for direction on how the service should be reported to support the use of codes.
Radiology
- Changes to 74022 – radiologic examination, complete acute abdomen series.74022 includes two or more views of the abdomen. (ex. Leg, supine. Erect, decubitus) and a single view of the chest.
- Gastrointestinal tract subsections have several revisions, including the addition of two new codes and five deleted codes.
- Positron Emission Tomography (PET) studies. Five new codes and three codes revised to support better documentation of imaging performed.
Pathology and Laboratory
- Therapeutic drug assays new code additions.
- 80145 – adalimutab
- 80230 – infliximab
- 80235 – lacosamide
- 80187 – posaconazole
- 80280 – vedolizumab
- 80285 – voriconazole
Changes to proprietary laboratory analyses (PLA) codes.
Medicine
- 90694 is a new influenza vaccine code. This code is used to report a preservative-free vaccine administered intramuscularly.
- Two codes added for a retinal drawing for clarity as previous code: 92225 and 92226 were based on initial for subsequent, which does not change. New codes 92201 and 92202 were created to provide clarity.
- EEG codes for monitoring have changed significantly for long-term monitoring services. Refer to the new guidelines and the new table added to provide details for proper coding.
Surgery
- Integumentary system – changes to intermediate and complex repairs have been revised. New guidelines added for subsections for breast procedures. New autologous grafting codes created and codes for excision for chest wall tumors deleted and placed with new codes.
- Musculoskeletal system – new codes created to report needle insertions into the muscle with no injection. Six codes created for manual preparation and insertion of drug delivery devices, including the removal of devices.
- Respiratory system – Nine nasal/sinus endoscopy codes are revised with parenthetical notes added for clarity.
- Cardiovascular system – Three codes for pericardiocentesis are deleted. (33010, 33011, 33015) and no longer require coding for initial or subsequent service. There are three new pericardial drainage codes. (33017, 33018, 33019). Code deletions for ascending aorta graft code, 33860 with to additions, 33858 and 33859. Transverse arch graft 33870 is deleted and replaced with 33871.
- Digestive system – 46945 internal hemorrhoidectomy codes are revised to include without imaging guidance. Cat III code 0249T is now a Cat I code 46948 internal hemorrhoidectomy by transanal hemorrhoidal dearterialization.
- Male genital system – 54640 – revision for reporting hernia repair when performed during the same session.
- Nervous system – 62270 and 62272 spinal puncture codes are revised to be parent codes to report imaging guidance. Use 62328 to report fluoroscopy CT guidance during a diagnostic spinal puncture. Use 62329 for fluoroscopy or CT guidance for therapeutic spinal puncture.
- Nerve injection codes have significant changes, with eighteen codes revised. Three codes deleted, and two codes added.
Finally, there have been some guideline changes to modifiers. Notes instruct not to use bilateral modifier 50 with add-on codes. When using additional or supplemental, it is advised to use add-on code twice using RT and LT. This applies to inpatient and outpatient procedures. Always check with your payer as there are times they may have different reporting recommendations for reporting based on their claims systems, especially related to bilateral services. Modifier 63 has added Medicine section codes allowed to be reported with modifier 63, for infants less than 4 kg.
These changes are a high-level to capture changes that may impact your billing processes for 2020. See references for more detail as well as current code books.
References:
Refer to the downloadable CPT file: American Medical Association CPT Data File You will find key descriptors and coding guidelines.
American Academy of Professional Coders: Master 2020 CPT Changes Expert Overview