2018 CPT Code Changes
Written By: Toni Elhoms, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainern Director of Coding/Compliance Consulting ServicesnnIt’s that time of the year again! The new 2018 CPT code changes took effect January 1st. Understanding the myriad of upcoming changes is crucial to obtaining the proper reimbursement for your services! The changes for 2018 address a number of interrelated issues. Clinical practice and technology have evolved and several issues required much needed CPT expansion and clarification. CPT 2018 offers changes that affect nearly every specialty.nn*Please note, this article is not an all-inclusive list; review your 2018 CPT book for complete descriptions of all changes. Appendix B of 2018 CPT provides a summary of additions, deletions, and revisions.nn
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Highlights of the most significant changes:
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New CPT Modifiers
nTwo new modifiers were added to this year’s CPT update. They should be reported with services that are identified as being either habilitative or rehabilitative in nature, such as physical medicine and rehabilitation codes. This will allow the payer the ability to differentiate habilitative from rehabilitative services. This differentiation is required by the Patient Protection and Affordable Care Act (PPACA).nnModifier 96 – Habilitative Services: When a service or procedure that may either be habilitative in nature or rehabilitative in nature is provided for habilitative purposes. 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.nnModifier 97 – Rehabilitative Services: When a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes. 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.n
Observation Care Services
nCPT 2018 added the verbiage “outpatient hospital” to the code descriptions for observation care services (CPT codes 99217 – 99220). These changes affect one observation discharge code and three observation care codes. The intent behind this revision was to clarify that observation services are specific to outpatient status (Place of Service Code 22). These codes should not be reported for a patient that was admitted to the hospital.n
Evaluation & Management Services
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There are 3 new codes for psychiatric collaborative care management services. There is one new code for general behavioral health integration care service. INR monitoring services were also revised deleting 2 codes and creating 2 new codes for INR home and outpatient INR monitoring services.n
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- 99483 (Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home).n
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- For cognitive-assessment services, report 99483 instead of G0505.
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- 99492 (Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional).n
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- For collaborative care management (CoCM) services, report 99492, 99493 and 99494 in place of G0502, G0503 and G0504.
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- 99493 (Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities).n
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- For collaborative care management (CoCM) services, report 99492, 99493 and 99494 in place of G0502, G0503 and G0504.
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- 99494 (Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities).n
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- For collaborative care management (CoCM) services, report 99492, 99493 and 99494 in place of G0502, G0503 and G0504.
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- 99484 (Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month).n
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- For care management-focused behavioral health integration (BHI), report 99484 instead of G0507.
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- 93792 – Patient/caregiver training for initiation of home international normalized ratio (INR) monitoring under the direction of a physician or other qualified health care professional, face-to-face, including use and care of the INR monitor, obtaining blood sample, instructions for reporting home INR test results, and documentation of patient’s/caregiver’s ability to perform testing and report results
- 93793 – Anticoagulant management for a patient taking warfarin, must include review and interpretation of a new home, office, or lab international normalized ratio (INR) test result, patient instructions, dosage adjustment (as needed), and scheduling of additional test(s), when performed
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Flu Vaccinations
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Two new flu-vaccine codes were added in 2018. Both CPT codes pertain to quadrivalent vaccinations. There is also a new CPT code for intramuscular Shingles vaccine.n
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- 90756 – Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use
- 90682 – Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
- 90750 – Zoster (shingles) vaccine (HZV), recombinant, sub-unit, adjuvanted, for intramuscular use
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Anesthesia
nAnesthesia services underwent expansion in this year’s CPT update. There are 2 new CPT codes for upper GI endoscopic procedures and 3 new codes for lower and upper/lower intestinal endoscopic procedures. There were several deletions of low volume codes.n
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- 00731 – Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified
- 00732 – Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; endoscopic retrograde cholangiopancreatography (ERCP)
- 00811 – Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified
- 00812 – Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy
- 00813 – Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum
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Spine Surgery
nBone marrow aspiration codes underwent revision in this year’s CPT update. A new code was added to reflect more accurate procedural options. CPT code 20939 was added to replace CPT code 38220 when performing bone marrow aspiration for spine surgery only.n
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- 20939 – Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (List separately in addition to code for primary procedure)
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nPre-Sacral Interbody Fusion category III code 0309T was deleted. CPT now instructs coders/surgeons to report CPT code 22899 for unlisted spinal procedure in place of 0309T.n
Diagnostic Radiology
nThe most significant changes this year for diagnostic radiology involve chest x-ray and abdominal x-ray codes. For chest x-rays, there are 4 new CPT codes to replace 9 code deletions. CPT codes for chest x-rays are now selected based on the number of views instead of the type of radiologic view.n
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- 71045 – Radiologic examination, chest; single view
- 71046 – Radiologic examination, chest; 2 views
- 71047 – Radiologic examination, chest; 3 views
- 71048 –Radiologic examination, chest; 4 or more views
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nAbdominal x-rays also received revisions with this year’s CPT update. There are 3 new CPT codes to replace 3 code deletions. CPT codes for abdominal x-rays are now selected based on the number of views instead of the type of radiologic view.n
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- 74018 – Radiologic examination, abdomen; 1 view
- 74019 – Radiologic examination, abdomen; 2 views
- 74021 – Radiologic examination, abdomen; 3 or more views
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All of us at Welter Healthcare Partners, we would like to extend our warmest wishes for you this holiday season! As we spend time with family and friends, we reflect on the joyous year we have had due to our clients and those who support and appreciate the work that we do. Our office will operate on a “holiday schedule” as shown below to celebrate the holidays and allow our staff time to spend with their family and friends.n
As most medical practices are aware, not all cases are easy to navigate using the latest medical standards. The information below highlights a complicated surgical case along with the correct CPT and ICD-10 codes. Do you have a complicated surgery case need help with coding? Welter Healthcare Partners would love to help! Please upload the operative note by clicking on the link below. Remember to remove ALL patient protected health information and organization identifiers. Welter Healthcare Partners will not use any medical records submitted in which PHI is not removed and protected.nn
There is a lot of confusion surrounding reporting for transitional care management (TCM) services. CPT offers the following options to report TCM services:n
On Nov. 2, CMS 
All of us at Welter Healthcare Partners, would like to wish our clients, families and friends a Happy Thanksgiving! We are grateful for the relationships we have formed and for your continued to support of Welter Healthcare Partners. In observance of the holiday, we will be closed on