CPT 2020 revisions took effect on January 1, 2020. In Part 1 of our series on these changes, we discussed the overall revisions, as well as the specific changes for the Surgery section.
In Part 2, we continue with a discussion of changes in the Evaluation and Management, and Medicine sections, along with an overview of updates in the Radiology, Pathology and Laboratory, and the new Category III codes.
Evaluation and Management Section
The Evaluation and Management Section had minimal changes with 6 new codes, 1 revision, and 1 deletion (AAP News, 2019). An ongoing theme of these changes is online medicine and patient instituted health monitoring. For example, 3 of these new codes and the code deletion are for online digital evaluation and management (E/M) services. These new codes are found in a new heading within the Non-Face-to-Face-Services subsection. Code 99444 for online E/M services was deleted and replaced with 3 time-based codes: 99421, 99422, and 99423 for 5-10, 11-20, and 21 or more minutes cumulative time, respectively. Note that these codes are used for patient-initiated digital communications that require a clinical decision that would usually be provided in the office setting. There are extensive guidelines and parenthetical notes on the elements of the codes and what can and cannot be included in determining the cumulative time. For example, clinical staff time is not calculated as part of the cumulative time.
There are also 2 new codes for self-measured blood pressure using a device that has been clinically validated for accuracy. Code 99473 is used for patient education and training on calibration of the device and is used only once for the same device. Code 99474 is used for the review and averaging of individual readings, and communication of a treatment plan for the patient. Note that this code may only be reported once in a calendar month.
The final E/M changes are for remote physiological monitoring treatment management services. Code 99457 was added in 2019 for these services and was revised for 2020 to include the first 20 minutes of service, with add-on code 99458 created for each additional 20 minutes. These services are provided when the results of the remote monitoring are used to evaluate and update a given treatment plan. Interactive communication with the patient and/or caregiver during the month is essential to these codes, and the device must be ordered by the provider and be FDA-approved.
While the changes to E/M codes were not extensive for 2020, look for significant changes in 2021, as the Office and Other Outpatient Services codes are completely revamped with extensive additions of guideline additions, revisions, and restructuring of codes (AMA, 2019). The selection of codes in 2021 will be based on either medical decision making or time. More details on these changes will become available later into 2020.
This section had a total of 10 revisions, 21 deletions, and 47 new codes. A brief review of these changes is listed; see your CPT book for more information and important guideline and note additions.
- Two new vaccine codes, 90694, for influenza, and, 90619, Meningococcal conjugate, are pending FDA approval.
- Two new time-based biofeedback codes, 90912 and 90913, replace code 90911.
- Two extended ophthalmoscopy codes, 92201 and 92202, were added.
- Code 92548 was revised, and new code 92549 added for computerized dynamic posturography sensory organization test with motor control (MCT) and adaptation test (ADT).
- The new add-on code 93356, which replaces Category III code 0399T, was added for myocardial strain imaging using speckle tracking.
- 2 new codes, 93985 and 93986, were added for duplex scan of arterial inflow and venous outflow. These services are performed for vessel assessment prior to creation of hemodialysis access.
- Coding for EEG services was completely revamped, with code deletions, guideline changes, and 23 new codes, 95700-95726. The codes are subdivided by professional and technical services and duration. See the Long-Term EEG Monitoring Table in CPT. Also, note that there is an error in the table; the 10th row, 4th column, should read 95708 X 2 (per errata for 2020).
- Multiple code deletions in the Health Behavior Assessment and Intervention heading made way for 9 new codes to reflect current clinical practice. The codes, 96156-96171, are for assessment- and time-based interventions for individual, group, and family services.
- 2 new codes, 97129 and 97130, replace deleted code 97127. These are time-based codes tor therapeutic interventions that focus on cognitive function.
- 3 new codes, 98970, 98971, and 98972, were added for Qualified Nonphysician Health Care Professional Online Evaluation and Management Services. These descriptions mirror the codes found in the Evaluation and Management section for these services performed by a physician or other QHP discussed in the E/M changes above.
There were a total of 12 new, 18 revised, and 15 deleted codes for this section. There were 2 new codes in upper gastrointestinal tract imaging; 74221 for double-contrast radiological exam of the esophagus, and add-on code 74248 for radiologic small intestine follow-through. This caused the revision of 5 codes and the deletion of 4 in this area. A new coding structure was put in place for myocardial PET scan codes as technology for these studies has changed substantially; often, PET scans are done concurrently with CT transmission scans for better anatomical visualization. The changes include 3 revised, 2 deleted, and 6 new codes for myocardial PET or PET/CT scans; 78429, 78430, 78431, 78432, 78433, 78433. The last change in the radiology section is for radiopharmaceutical localization of tumors and inflammatory processes. These codes have been restructured with 5 code revisions, 3 deletions, and 4 new codes. Code selection is based on whether planar or SPECT imaging is used, how many areas are imaged, the number of days of imaging, and whether CT transmissions are performed at the same time. The 4 new codes report this localization of tumor or inflammatory process; 78830, 78831, 78832, and add-on code 78835.
Pathology and Laboratory Section
There were extensive changes in this section, and a brief overview of the changes follows as the codes are generally assigned via chargemaster. See Appendix B of CPT for a comprehensive list of the new, deleted, and revised codes. There were 6 new therapeutic drug assay codes, along with 4 new Tier I molecular pathology codes, 3 new multianalyte assay codes with algorithmic analyses (MAAA) codes, and 1 new microbiology code. The area with the most significant number of changes was for the Proprietary Laboratory Analyses (PLA) codes, which had 1 revision, 5 deletions, and 75 new codes. These codes are released on a quarterly basis and consist of 4 numerals and the letter U. A comprehensive list of all codes is found in Appendix O.
Category II and III Codes
Category II codes are supplemental tracking codes used for performance measures; the use of the codes is optional. This year, there were 3 code revisions, 1 deletion, and 5 new Category II codes. The changes related to eye exams for people with diabetes and specific reporting of A1c measures for diabetes management.
Category III codes are temporary tracking codes for emerging technology. The codes may be listed for a maximum of 5 years, unless special circumstances apply. This year, there were a total of 51 new Category III codes, with 11 deletions and 1 revision. See Appendix B for a complete listing of codes.