Coding Corner

Overview

The CPT code set for 2019 contains 10, 294 codes.

The total number of changes for 2019 equate to 335.

• 212 new codes
• 50 revised codes
• 73 deleted codes

Evaluation & Management

• Evaluation & Management

• The guidelines in the Home Services subsection have been revised to expand the definition of home. In addition to a private residence, home may also include temporary lodging or short- term accommodations. Short-term accommodations may include hotels, campgrounds, hostels, or cruise ships.

• Interprofessional Telephone/Internet Consultation (2 new, 4 revised)

  A revision has been made to the heading for Interprofessional Telephone/Internet Consultation and the guidelines have also been revised. The current codes 99446-99449 have been revised to include electronic health record and two new codes have been added to this subsection.

  Code 99451 has been established to report interprofessional consultation services provided by a consultative physician and code 99452 to report interprofessional referral services provided by a treating/requesting physician or other qualified health care professional.

  • The patient for whom the interprofessional telephone/internet/electronic health record consultation is requested may be either a new patient to the consultant or an established patient with a new problem or an exacerbation of an existing problem. However, the consultant should not have seen the patient in a face-to-face encounter within the last 14 days. When the telephone/internet/electronic heath record consultation leads to a transfer of care or other face-to-face service (e.g., a surgery, a

    hospital visit. Or a scheduled office evaluation of the patient) within the next 14 days or next available appointment date of the consultant, these codes are not reported.

  • If more than one telephone/internet/electronic health record contact is required to complete the consultation request, the entirety of the service and the cumulative discussion and information review time should be reported with a single code.

  • The written or verbal request for telephone/internet/electronic health record advice by the treating/requesting physician or other qualified health care professional should be documented in the patient’s medical record.

  • Telephone/internet/electronic health record consultations of less than five minutes should not be reported.

  • When the sole purpose of the telephone/internet/electronic health record communication is to arrange a transfer of care or other face-to-face service, these codes are not reported.

• A new subsection, Digitally Stored Data Services/Remote Physiologic Monitoring, and guidelines have been added to the E&M Services section. With the addition of this new subsection, two new codes have been added, one code deleted, and one code resequenced. These new codes are specific to physiologic monitoring services (e.g., weight, blood pressure, and pulse oximetry). The guidelines specify that the device used must be a medical device as defined by the Food and Drug Administration and ordered by the physician/QHP.

  • Code 99453 has been added to report the remote monitoring of physiologic parameter(s) initial set-up and patient education, specifically on the use of the device. This code should be reported once for each episode of care, as defined by new guidelines.

  • Code 99454 has been established to report the device supply for daily recordings or programmed alert transmissions for 30-day periods.

  • To allow a more robust reporting of remote services, the current code 99091 (collection and interpretation of physiologic data) has been resequenced to this new subsection from the Medicine Miscellaneous subsection. If the services described by code 99091 are performed on the same day a patient presents for an E&M service, code 99091 is not reported separately. Report only once in 30-days. 99090 has been deleted.

• A new subsection, Remote Physiologic Monitoring Treatment Management Services, and guidelines have been added to the E&M Services section. A new code, 99457, has been established to report remote physiologic monitoring treatment management services for 20 minutes or more in a calendar month. Code 99457 requires interactive communication with the patient/caregiver during the month. As indicated in the guidelines, it is important to note that the device used to provide these services must be a medical device defined by the FDA, and it must be ordered by a physician/QHP.

  • Code 99457 may be reported during the same service period as chronic care management services (99487-99490), transitional care management services (99495, 99496), and behavioral health integration services (99484, 99492, 99493, 99494). However, time for each service should remain separate. Code 99457 requires live, interactive communication with the patient/caregiver and 20 minutes or more of clinical staff/physician or QHP time in a calendar month.

• Currently, there is no code to report Chronic Care Management Services provided by a physician/QHP of at least 30 minutes per calendar month. Code 99491 has been established to do this.

  • Code 99491 may not be reported with code 99490, chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.

• Proposed HCPCS Level II Codes for Virtual Services

  • G2010, Remote evaluation of recorded video and/or images submitted by the patient (e.g., store and forward), including interpretation with verbal follow-up with the patient within 24 business hours, not originating from a related E&M service provided within the previous 7 days nor leading to an E&M service or procedure within the next 24 hours or soonest available appointment).

  • G2012, Brief communication technology based service, e.g., virtual check-in, by a physician or other qualified health care professional who may report E&M services provided to an established patient, not originating from a related E&M service provided within the previous 7 days nor leading to an E&M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion).

Surgery

General

• 2 codes for FNA biopsy without imaging	8 New codes for FNA biopsy with imaging guidance (bundled)	Deletion of 10022 (FNA biopsy with imaging guidance)
  • Revised code 10021 (initial lesion) • New code +10004 (each add’l)	• 10005-10012 • Imaging modality specific • 4 base codes for initial lesion • 4 add-on codes for each additional lesion

  FNA Biopsy: 2018 Compared to 2019
  2018		2019
  10021	FNA without imaging guidance	10021	FNA biopsy. w/o imaging guidance: first lesion
  		+10004	each additional lesion
  10022	FNA with imaging guidance	10005	FNA biopsy, ultrasound guidance: first lesion
  		+10006	each additional lesion
  		10007	FNA biopsy, fluoroscopic guidance: first lesion
  		+10008	each additional lesion
  		10009	FNA biopsy, CT guidance: first lesion
  		+10010	each additional lesion
  		10011	FNA biopsy, MR guidance: first lesion
  		+10012	each additional lesion

• Coding Tips

  • Multiple FNA Biopsies, Same Session, Separate Lesions

    • When multiple FNA biopsies are 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)

    • When FNA biopsies are 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

      • Regardless of whether the lesions are ipsilateral or contralateral to each other, and/or whether they are in the same or different organs/structures

  • FNA Biopsy + Core Biopsy, Same Session, Same Lesion

    • When FNA 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 the FNA biopsy and core needle biopsy are both performed on the same

      lesion, same session, same day, but use different types of imaging guidance

      • Report imaging guidance code for core needle biopsy with modifier 59

  • FNA Biopsy + Core Biopsy, Same Session, Different Lesions

    • 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

Integumentary

• Codes 11102, 11103, 11104, 11105, 11106, and 11107 have been established to describe distinct biopsy modalities, such as tangential, punch, and incisional biopsies. Guidelines and a table have been added to the Biopsy section to define and describe the use of these three modalities of biopsy. Codes 11100 and 11101 have been deleted as the new codes that provide more specificity to the biopsy procedures have been established. Several parenthetical notes have also been added directing users to specific anatomic biopsy codes located throughout the code set.

  These new codes (11102, 11104, 11106) individually define three distinct biopsy modalities in order to provide optimal description of the services performed: tangential, punch, and incisional biopsies. These modalities are reported based on the biopsy technique and the thickness of the sample. Add-on code 11103 may be reported in conjunction with codes 11102, 11104, and 11106, when additional biopsies of the same or different techniques are performed to sample separate/additional lesions. Add-on code 11105 may be reported in conjunction with codes 11104 and 11106, when additional biopsies of the same or different techniques are performed to sample separate/additional lesions. Add-on code 11107 may only be reported in conjunction with code 11106 for incisional biopsy.

Musculoskeletal System

• Codes 20932, 20933, and 20934 have been established to describe structural allograft procedures. There was no previous code for this work. These services are add-on services for fashioning and fixation of the allograft that should be reported in addition to the primary procedure such as a radical resection of the bone tumor.

  • +20932 Allograft, includes templating, cutting, placement and internal fixation, when performed; osteoarticular, including articular surface and contiguous bone (List separately in addition to code for primary procedure)
  • +20933 hemicortical intercalary, partial (i.e., hemicylindrical) (List separately in addition to code for primary procedure)
  • +20934 intercalary, complete (i.e., cylindrical) (List separately in addition to code for primary procedure)

• Injection for Knee Arthrography
  Code 27370 (Injection of contrast for knee arthrography) has been deleted and code 27369 has been established to report injection procedure for knee arthrography or enhanced CT/MRI knee arthrography.

  The AMA RUC RAW screen identified code 27370 for high-volume growth, and a recommendation was made to revise this code to reflect current practice. It was determined that if such extensive revision were needed, a new code should be created and to delete code 27370. Code 27370 did not include contrast enhanced CT/MRI knee arthrography. However, code 27369 can be reported for a knee injection for contrast knee arthrography or contrast enhanced CT/MRI knee arthrography.

  • Significant concerns that this code was being misreported for knee joint aspiration/injection
  • Reported close to 150,000 times in 2016
  • Family practice accounted for close to 25% of these services
  • Code 27370 was deleted based on possible misreporting
  • Added seven parenetical notes to clarify reporting of these services

Cardiovascular System

• Leadless Pacemaker Procedures – Category III codes 0387T, Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular, and 0388T, Transcatheter removal of permanent leadless pacemaker, ventricular, have been deleted and converted to new Category I codes 33724 and 33275.

  Coding Tips

  • Codes 0387T and 0388T included fluoroscopy, right ventriculography, and femoral venography intrinsic to the procedure, when performed. Code 0387T included device evaluation. Guidelines were provided in the Category III section that explained these services were included; however, the code descriptors of 0387T and 0388T did not state that they were included. Therefore, for 2019, these services are included in the new

    codes’ descriptors for clarity. Code 33274 includes device evaluation when performed

    during the same session. Device evaluation that is performed subsequent to the

    insertion or replacement procedure is reported with codes 93279, 93286, 93288, 93294 and 93296, as appropriate.

  • When a leadless pacemaker is replaced, the removal of the original pacemaker is included in code 33274. Therefore, the removal code 33275 should not be reported in conjunction with code 33274.

  • Code 33275 is reported when the leadless pacemaker is removed at a session subsequent to the insertion procedure.

  • Catheter insertion into the right ventricle for the purpose of insertion, replacement, or removal is included in codes 33274 and 33275.

  • Right catheterization may be reported separately, as appropriate, if complete right heart catheterization is performed for indications distinct from the leadless pacemaker procedure during the same session.

  • Cardiac Even Recorder Procedures-New technology has replaced codes 33282 and 33284 (patient-activated cardiac event recorder implantation and removal) with two new codes 33285 and 33286 to report insertion and removal of a subcutaneous cardiac rhythm monitor.

  • The term “patient-activated cardiac even record” has been updated with the term “subcutaneous cardiac rhythm monitor” in codes 33285 and 33286, in order to reflect current practice and terminology for these devices.

  • Programming is included in code 33285 (implantation).

• A new subsection, “Implantable Hemodynamic Monitors,” has been added to the Cardiovascular System.

  • New code 33289, Transcatheter implantation of a wireless pulmonary artery pressure sensor, provides pulmonary artery (PA) pressure (PAP), heart rate measuring and monitoring. This device is indicated for heart failure patients who have been hospitalized for heart failure in the previous year. Hemodynamic data is used by physicians or other qualified health care professionals for heart failure treatment with the goal of reducing heart failure hospitalizations.

  • code 93264 specifically involves pulmonary artery pressure measurements performed and transmitted by the patient and the population receiving this service requires intense follow up in both the optimization and continuation phase.

• Aortoventriculoplasty with Pulmonary Autograft- Code 33440 combines the services identified by two separate Category I codes into a single code. The descriptor for this new code includes language and components from the Ross procedure (33413) and the Konno procedure (33412).

  CPT Code	Description
  33440	Ross-Konno procedure
  33411	Ross-Konno, annulus enlargement, noncoronary sinus
  33412	Konno procedure
  33413	Ross procedure, valve preserving aortic aneurysm repair

• PICC Procedures: Imaging Guidance-no longer reported separately

  2 New codes for PICC placement that bundle imaging guidance	2 Existing codes revised to specify without imaging guidance	Existing PICC replacement code revised to include imaging guidance
  36572	-36568	-36584
  36573	-36569

  • When ultrasound guidance is performed, evaluation of the potential puncture sites, patency of the entry vein, and real-time ultrasound visualization of needle entry into the vein should be documented.

  • Imaging to document the final catheter position or to confirm location of the catheter tip is not reported separately, as codes 36572, 36573, and 36584 include this imaging.

  • If confirmation of catheter-tip location is not performed by the physician or other qualified health care professional performing the PICC insertion or replacement, then codes 36572, 36573, and 36584 are reported with modifier 52 appended to reflect reduction in service.

  Hemi and Lymphatic Systems

  • Code 38531, Biopsy or excision of lymph node(s); open, inguinofemoral node(s), was created to report open biopsy or excision of inguinofemoral nodes. Because this procedure may be performed bilaterally, modifier 50 should be appended to code 38531, in order to identify the bilateral procedure, when performed.

  Digestive System

  • Code 47360 has been deleted; codes 43762 and 43763 have been added; and three parenthetical notes have been added.

    • Code 43760 described percutaneous change of gastrostomy tube, performed without imaging or endoscopic guidance. To differentiate the work of a straightforward G tube placement that requires revision, code 43760 has been deleted and two new codes created.

  • Code 43762 describes replacement of gastrostomy tube without the need for revision of the gastrostomy tract.

  • Code 43763 describes a more complex procedure that requires revision of the gastrostomy tract.

  Urinary System

  • Code 50395 has been deleted ad codes 50436 and 50437 have been added to describe dilation of an existing urinary tract. Previously, code 50395 was intended to identify accessing an existing tract to dilate the opening to accommodate devices that will be used beyond the dilated tract. Code 50432 is intended to identify an initial placement of a catheter or device within the urinary tract. Because code 50395 could be misconstrued to include establishing an initial nephrostomy tract, this code has been deleted and two new codes 50436, Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance and all associated radiological supervision and interpretation, with post procedure tube placement, when performed, and 50437, Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance and all associated radiological supervision and interpretation, with post procedure tube placement, when performed including new access into the renal collecting system, established to differentiate dilation of an existing tract from initiating a new tract.

  • Code 53854 has been established to report water vapor thermotherapy for the destruction of prostate tissue. The difference between 53852 and 53854 is the way in which RF is applied (direct vs indirect) to create and deliver the thermotherapy energy to the prostate tissue for destruction. Code 53854 includes indirect application of RF energy to create thermotherapy in the form of water vapor or steam applied to the prostate tissue to cause tissue destruction.

  Radiology

  • Code 76391 has been established to report magnetic resonance elastography (MRE). MRE is a new diagnostic imaging technology that uses propagating mechanical shear waves to quantitively image the mechanical properties of tissue (i.e. tissue stiffness) and provides a quantitative counterpart to the traditional diagnostic technique of palpation. MRE requires the use of a magnetic resonance imaging (MRI) scanner, with specially modified hardware and software, to generate and image micron-level vibrations.

    • Cirrhotic liver (measures fibrosis or scarring)

    • Breast cancer

    • Brain: Potential uses-Alzheimer’s disease, brain cancer, and multiple sclerosis

    • Skeletal muscle-damaged muscle

      Document elastogram and measurements

  • Contrast-Enhanced Ultrasound

    • Not the usual iodinated contrast used in CT or the gadolinium contrast used in MR

    • Gas-filled microbubbles: highly echogenic and reflect sound very intensely

    • Used to measure vascularity: more blood flow=more echoes

    • Bubbles are quickly broken down and the gas is exhaled-not excreted thru kidneys

    • Two new codes, 76978, 76979), have been created to report noncardiac ultrasound, targeted dynamic microbubble sonographic contrast characterization.

      • Code 76978 describes targeted dynamic microbubble sonographic contrast evaluation performed of a lesion previously demonstrated on a diagnostic imaging study.

      • Code 76979 is an add-on code, so it should not be reported as a stand-alone code. Code 76979 describes targeted dynamic microbubble sonographic contrast evaluation of each additional lesion previously demonstrated on a diagnostic imaging study. In addition, it can only be reported if a separate injection is performed during evaluation of each additional lesion.

      • A parenthetical note has been added precluding the use of codes 76978 and 76979 with 96374. Code 96374, Therapeutic, prophylactic, or diagnostic injection (specify substance/drug); intravenous push, single or initial substance/drug, is not reported separately because it is inherently included as part of microbubble sonographic contrast evaluation (76978, 76979).

  • Three new codes (76981, 76982, 76983) have been established to report ultrasound elastography. These new Category I codes have been created because of an increase in usage frequency of code 0346T. Therefore, these new Category I codes are now appropriate to report ultrasound elastography.

    • 76981 Ultrasound, elastography; parenchyma (e.g., organ)

    • 76982 first target lesion

      o +76983 each additional target lesion (List separately in addition to code for primary procedure)

    • For evaluation of a parenchymal organ and lesion(s) in the same parenchymal organ at the same session, report only 76981.

    • Do not report 76983 more than two times per organ

    • Deletion of 0346T Ultrasound, elastography

    • Related Revision is 91200 Liver elastography, mechanically induced shear wave (e.g., vibration), without imaging, with interpretation and report

  • Ultrasound Bone Density Measurement

    • Code 0508T, Pulse-echo ultrasound bone density measurement resulting in indicator of axial bone mineral density, tibia, has been established to report pulse-echo ultrasound bone density measurements for bone mineral density (BMD) analysis. As this is a new technology to measure bone density, existing CPT codes do not accurately describe this procedure. Currently, codes 76977, 77080, and 77081 are used to report bone density measurements and/or using X-ray technology. In contrast, new code 0508T reports the measurements of axial bone mineral density using ultrasound technology.

  • Breast MRI Bundled with CAD: Rationale for New Codes

    Existing breast MRI codes (77058, 77059) and Category III CAD code 0159T have been deleted with four new codes (77046, 77047, 77048, 77049) to report MRI of the breast. The revisions have been made to align with the structure of other breast imaging families. With changes in clinical practice, these four new magnetic resonance codes that specify the use of contrast materials and “include computer-aided detection (CAD), when performed” will enable accurate reporting of the specific breast imaging performed.

    • Unilateral vs bilateral

    • Without contrast vs without & with contrast

    • 77046 Magnetic resonance imaging, breast, without contrast material; unilateral

    • 77047 bilateral

    • 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

  • Deletion of 76001, Fluoroscopy (separate procedure), up to 1-hour physician or other qualified health care professional time

    • Changes in practice pattern

      • Nonradiologic physician have become more comfortable with fluoroscopically guided procedures

      • Rare any longer for two physicians from different specialties to do procedures together

      • Fluoroscopy is now bundled into most procedures

      • Very low volume service

  • Vitamin B-12 Nuclear Medicine Codes Deleted
    To ensure that the CPT code set reflects current clinical practice, codes 78270, Vitamin B-12 absorption study (e.g. Schilling test); without intrinsic factor 78271, Vitamin B-12 absorption study (e.g., Schilling test); with intrinsic factor; and 78272, Vitamin B-12 absorption studies combined, with and without intrinsic factor, have been deleted due to low utilization.

  Tier 1 Molecular Pathology Procedures
  81163	BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full sequence analysis
  81164	BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (i.e., detection of large gene rearrangements)
  81165	BRCA1 (BRCA1, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full sequence analysis
  81166	BRCA1 (BRCA1, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (i.e., detection of large gene rearrangements)
  81167	BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (i.e., detection of large gene rearrangements)
  81171	AFF2 (AF4/FMR2 family, member 2 [FMR2]) (e.g., fragile X mental retardation 2 [FRAXE]) gene analysis; evaluation to detect abnormal (e.g., expanded) alleles
  81172	AFF2 (AF4/FMR2 family, member 2 [FMR2]) (e.g., fragile X mental retardation 2 [FRAXE]) gene analysis; characterization of alleles (e.g., expanded size and methylation status)
  81173	AR (androgen receptor) (e.g., spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; full gene sequence
  81174	AR (androgen receptor) (e.g., spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; known familial variant
  81177	ATN1 (atrophin 1) (e.g., dentatorubral-pallidoluysian atrophy) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles
  81178	ATXN1 (ataxin 1) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles
  81179	ATXN2 (ataxin 2) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles
  81180	ATXN3 (ataxin 3) (e.g., spinocerebellar ataxia, Machado-Joseph disease) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles
  81181	ATXN7 (ataxin 7) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles
  81182	ATXN8OS (ATXN8 opposite strand [non-protein coding]) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles
  81183	ATXN10 (ataxin 10) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles
  81184	ACNA1A (calcium voltage-gated channel subunit alpha1 A) (e.g., spinocerebellar ataxia) gene analysis; evaluation to detect abnormal (e.g., expanded) alleles
  81185	CACNA1A (calcium voltage-gated channel subunit alpha1 A) (e.g., spinocerebellar ataxia) gene analysis; full gene sequence
  81186	CACNA1A (calcium voltage-gated channel subunit alpha1 A) (e.g., spinocerebellar ataxia) gene analysis; known familial variant
  81187	CNBP (CCHC-type zinc finger nucleic acid binding protein) (e.g., myotonic dystrophy type 2) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles
  81188	CSTB (cystatin B) (e.g., Unverricht-Lundborg disease) gene analysis; evaluation to detect abnormal (e.g., expanded) alleles
  81189	CSTB (cystatin B) (e.g., Unverricht-Lundborg disease) gene analysis; full gene sequence
  81190	CSTB (cystatin B) (e.g., Unverricht-Lundborg disease) gene analysis; known familial variant(s)
  81204	AR (androgen receptor) (e.g., spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; characterization of alleles (e.g., expanded size or methylation status)
  81233	BTK (Bruton's tyrosine kinase) (e.g., chronic lymphocytic leukemia) gene analysis, common variants (e.g., C481S, C481R, C481F)
  81234	DMPK (DM1 protein kinase) (e.g., myotonic dystrophy type 1) gene analysis; evaluation to detect abnormal (expanded) alleles
  81236	EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (e.g., myelodysplastic syndrome, myeloproliferative neoplasms) gene analysis, full gene sequence
  81237	EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (e.g., diffuse large B-cell lymphoma) gene analysis, common variant(s) (e.g., codon 646)
  81239	DMPK (DM1 protein kinase) (e.g., myotonic dystrophy type 1) gene analysis; characterization of alleles (e.g., expanded size)
  81271	HTT (huntingtin) (e.g., Huntington disease) gene analysis; evaluation to detect abnormal (e.g., expanded) alleles
  81274	HTT (huntingtin) (e.g., Huntington disease) gene analysis; characterization of alleles (e.g., expanded size)
  81284	FXN (frataxin) (e.g., Friedreich ataxia) gene analysis; evaluation to detect abnormal (expanded) alleles
  81285	FXN (frataxin) (e.g., Friedreich ataxia) gene analysis; characterization of alleles (e.g., expanded size)
  81286	FXN (frataxin) (e.g., Friedreich ataxia) gene analysis; full gene sequence
  81289	FXN (frataxin) (e.g., Friedreich ataxia) gene analysis; known familial variant(s)
  81305	MYD88 (myeloid differentiation primary response 88) (e.g., Waldenstrom's macroglobulinemia, lymphoplasmacytic leukemia) gene analysis, p.Leu265Pro (L265P) variant
  81306	NUDT15 (nudix hydrolase 15) (e.g., drug metabolism) gene analysis, common variant(s) (e.g., *2, *3, *4, *5, *6)
  81312	PABPN1 (poly[A] binding protein nuclear 1) (e.g., oculopharyngeal muscular dystrophy) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles
  81320	PLCG2 (phospholipase C gamma 2) (e.g., chronic lymphocytic leukemia) gene analysis, common variants (e.g., R665W, S707F, L845F)
  81329	SMN1 (survival of motor neuron 1, telomeric) (e.g., spinal muscular atrophy) gene analysis; dosage/deletion analysis (e.g., carrier testing), includes SMN2 (survival of motor neuron 2, centromeric) analysis, if performed
  81333	TGFBI (transforming growth factor beta-induced) (e.g., corneal dystrophy) gene analysis, common variants (e.g., R124H, R124C, R124L, R555W, R555Q)
  81336	SMN1 (survival of motor neuron 1, telomeric) (e.g., spinal muscular atrophy) gene analysis; full gene sequence
  81337	SMN1 (survival of motor neuron 1, telomeric) (e.g., spinal muscular atrophy) gene analysis; known familial sequence variant(s)
  81343	PPP2R2B (protein phosphatase 2 regulatory subunit Bbeta) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles
  81344	TBP (TATA box binding protein) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles
  81345	TERT (telomerase reverse transcriptase) (e.g., thyroid carcinoma, glioblastoma multiforme) gene analysis, targeted sequence analysis (e.g., promoter region)

  Pathology & Lab

  • In the Pathology and Laboratory section, 95 new codes have been added, of which 44 are new PLS codes (0018U-0061U0 and 45 are Tier 1 molecular pathology codes; five have been deleted, of which two are deleted PLA codes (0004U-0015U) and three are tier 1 molecular pathology codes (81211, 81213, 81214); and 11 are revised tier 1 and tier 2 molecular pathology codes (81216, 81244, 81287, 81237, 81400,-81405, 81407). The Tier 1 Molecular Pathology Procedures subsection changes include the addition of 45 new codes (81163-81167, 81171-81174, 81177-81190, 81204, 81233, 81234, 81236, 81237, 81239, 81271, 81274, 81284-81286, 81289, 81305, 81306, 81312, 81320, 81333, 81336, 81337, 81343-81345) and revision of code 81162 to conform to the parent code structure. As for the Tier 2 Molecular Pathology Procedures subsection, the changes include revisions in the code descriptors for six codes (81400-81405, 81407).

   

  Tier 2 Molecular Pathology Procedures
  81143	Genetic testing for severe inherited conditions (eg, cystic fibrosis, Ashkenazi Jewish-associated disorders [eg, Bloom syndrome, Canavan disease, Fanconi anemia type C, mucolipidosis type VI, Gaucher disease, Tay-Sachs disease], beta hemoglobinopathies, phenylketonuria, galactosemia), genomic sequence analysis panel, must include sequencing of at least 15 genes (eg, ACADM, ARSA, ASPA, ATP7B, BCKDHA, BCKDHB, BLM, CFTR, DHCR7, FANCC, G6PC, GAA, GALT, GBA, GBE1, HBB, HEXA, IKBKAP, MCOLN1, PAH)
  81518	Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 11 genes (7 content and 4 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithms reported as percentage risk for metastatic recurrence and likelihood of benefit from extended endocrine therapy
  81596	Infectious disease, chronic hepatitis C virus (HCV) infection, six biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, and haptoglobin) utilizing serum, prognostic algorithm reported as scores for fibrosis and necroinflammatory activity in liver
  82642	Dihydrotestosterone (DHT)
  83722	Lipoprotein, direct measurement; small dense LDL cholesterol

   

  Proprietary Laboratory Analysis (PLA)
  0018U	Oncology (thyroid), microRNA profiling by RT-PCR of 10 microRNA sequences, utilizing fine needle aspirate, algorithm reported as a positive or negative result for moderate to high risk of malignancy
  0019U	Oncology, RNA, gene expression by whole transcriptome sequencing, formalin-fixed paraffin-embedded tissue or fresh frozen tissue, predictive algorithm reported as potential targets for therapeutic agents
  0021U	Oncology (prostate), detection of 8 autoantibodies (ARF 6, NKX3-1, 5’-UTRBMI1, CEP 164, 3’-UTR-Ropporin, Desmocollin, AURKAIP-1, CSNK2A2), multiplexed immunoassay and flow cytometry serum, algorithm reported as risk score
  0022U	Targeted genomic sequence analysis panel, non-small cell lung neoplasia, DNA and RNA analysis, 23 genes, interrogation for sequence variants and rearrangements, reported as presence/absence of variants and associated therapy(ies) to consider
  0023U	Oncology (acute myelogenous leukemia), DNA, genotyping of internal tandem duplication, p.D835, p.I836, using mononuclear cells, reported as detection or non-detection of FLT3 mutation and indication for or against the use of midostaurin
  0024U	Glycosylated acute phase proteins (GlycA), nuclear magnetic resonance spectroscopy, quantitative
  0025U	Tenofovir, by liquid chromatography with tandem mass spectrometry (LC-MS/MS), urine, quantitative
  0026U	Oncology (thyroid), DNA and mRNA of 112 genes, next-generation sequencing, fine needle aspirate of thyroid nodule, algorithmic analysis reported as a categorical result ("Positive, high probability of malignancy" or "Negative, low probability of malignancy")
  0027U	JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene analysis, targeted sequence analysis exons 12-15
  0029U	Drug metabolism (adverse drug reactions and drug response), targeted sequence analysis (ie, CYP1A2, CYP2C19, CYP2C9, CYP2D6, CYP3A4, CYP3A5, CYP4F2, SLCO1B1, VKORC1 and rs12777823)
  0030U	Drug metabolism (warfarin drug response), targeted sequence analysis (ie, CYP2C9, CYP4F2, VKORC1, rs12777823)
  0031U	0031UCYP1A2 (cytochrome P450 family 1, subfamily A, member 2) (eg, drug metabolism) gene analysis, common variants (ie, *1F, *1K, *6, *7)
  0032U	COMT (catechol-O-methyltransferase) (eg, drug metabolism) gene analysis, c.472G>A (rs4680) variant
  0033U	HTR2A (5-hydroxytryptamine receptor 2A), HTR2C (5-hydroxytryptamine receptor 2C) (eg, citalopram metabolism) gene analysis, common variants (ie, HTR2A rs7997012 [c.614-2211T>C], HTR2C rs3813929 [c.759C>T] and rs1414334 [c.551-3008C>G])
  0034U	TPMT (thiopurine S-methyltransferase), NUDT15 (nudix hydroxylase 15) (eg, thiopurine metabolism) gene analysis, common variants (ie, TPMT *2, *3A, *3B, *3C, *4, *5, *6, *8, *12; NUDT15 *3, *4, *5)
  0035U	Neurology (prion disease), cerebrospinal fluid, detection of prion protein by quakinginduced conformational conversion, qualitative
  0036U	Exome (ie, somatic mutations), paired formalin-fixed paraffin-embedded tumor tissue and normal specimen, sequence analyses
  0037U	Targeted genomic sequence analysis, solid organ neoplasm, DNA analysis of 324 genes, interrogation for sequence variants, gene copy number amplifications, gene rearrangements, microsatellite instability and tumor mutational burden
  0038U	Vitamin D, 25 hydroxy D2 and D3, by LCMS/MS, serum microsample, quantitative
  0039U	Deoxyribonucleic acid (DNA) antibody, double stranded, high avidity
  0040U	BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis, major breakpoint, quantitative
  0041U	Borrelia burgdorferi, antibody detection of 5 recombinant protein groups, by immunoblot, IgM
  0042U	Borrelia burgdorferi, antibody detection of 12 recombinant protein groups, by immunoblot, IgG
  0043U	Tick-borne relapsing fever Borrelia group, antibody detection to 4 recombinant protein groups, by immunoblot, IgM
  0044U	Tick-borne relapsing fever Borrelia group, antibody detection to 4 recombinant protein groups, by immunoblot, IgG
  0045U	Oncology (breast ductal carcinoma in situ), mRNA, gene expression profiling by realtime RT-PCR of 12 genes (7 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as recurrence score
  0046U	FLT3 (fms-related tyrosine kinase 3) (eg, acute myeloid leukemia) internal tandem duplication (ITD) variants, quantitative
  0047U	Oncology (prostate), mRNA, gene expression profiling by real-time RT-PCR of 17 genes (12 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a risk score
  0048U	Oncology (solid organ neoplasia), DNA, targeted sequencing of protein-coding exons of 468 cancer-associated genes, including interrogation for somatic mutations and microsatellite instability, matched with normal specimens, utilizing formalin-fixed paraffin-embedded tumor tissue, report of clinically significant mutation(s)
  0049U	NPM1 (nucleophosmin) (eg, acute myeloid leukemia) gene analysis, quantitative
  0050U	Targeted genomic sequence analysis panel, acute myelogenous leukemia, DNA analysis, 194 genes, interrogation for sequence variants, copy number variants or rearrangements
  0051U	Prescription drug monitoring, evaluation of drugs present by LC-MS/MS, urine, 31 drug panel, reported as quantitative results, detected or not detected, per date of service
  0052U	Lipoprotein, blood, high resolution fractionation and quantitation of lipoproteins, including all five major lipoprotein classes and subclasses of HDL, LDL, and VLDL by vertical auto profile ultracentrifugation
  0053U	Oncology (prostate cancer), FISH analysis of 4 genes (ASAP1, HDAC9, CHD1 and PTEN), needle biopsy specimen, algorithm reported as probability of higher tumor grade
  0054U	Prescription drug monitoring, 14 or more classes of drugs and substances, definitive tandem mass spectrometry with chromatography, capillary blood, quantitative report with therapeutic and toxic ranges, including steady-state range for the prescribed dose when detected, per date of service
  0055U	ardiology (heart transplant), cell-free DNA, PCR assay of 96 DNA target sequences (94 single nucleotide polymorphism targets and two control targets), plasma
  0056U	Hematology (acute myelogenous leukemia), DNA, whole genome nextgeneration sequencing to detect gene rearrangement(s), blood or bone marrow, report of specific gene rearrangement(s)
  0057U	Oncology (solid organ neoplasia), mRNA, gene expression profiling by massively parallel sequencing for analysis of 51 genes, utilizing formalin-fixed paraffinembedded tissue, algorithm reported as a normalized percentile rank
  0058U	Oncology (Merkel cell carcinoma), detection of antibodies to the Merkel cell polyoma virus oncoprotein (small T antigen), serum, quantitative
  0059U	Oncology (Merkel cell carcinoma), detection of antibodies to the Merkel cell polyoma virus capsid protein (VP1), serum, reported as positive or negative
  0060U	Twin zygosity, genomic-targeted sequence analysis of chromosome 2, using circulating cell-free fetal DNA in maternal blood
  0061U	Transcutaneous measurement of five biomarkers (tissue oxygenation [StO2], oxyhemoglobin [ctHbO2], deoxyhemoglobin [ctHbR], papillary and reticular dermal hemoglobin concentrations [ctHb1 and ctHb2]), using spatial frequency domain imaging (SFDI) and multi-spectral analysis

   

  Medicine

  • New vaccine product code 90689 has been established in the Vaccines, Toxoids subsection to report pediatric quadrivalent influenza vaccine. This code carries the US Food and Drug Administration approval-pending symbol.
  • Code 92275, Electroretinography with Interpretation and report has been deleted and two new codes (92273, 92274 [electroretinography {ERG}]) have been added to the Ophthalmology/Special Ophthalmological Services/Other Specialized Services section.
    • Code 92273 describes ffERG, which measures overall retinal function
    • Code 92274 describes mfERG, which provides tracings of multiple locations in the retina
  • New code 95836 has been established, code 95829 relocated, and new Electrocorticography subsection with guidelines added to identify electrocorticography (ECoG) performed over a 30-day period. In addition, parenthetical notes have been added to direct users regarding the intended use of the new code, as well as direct users to codes for programming for chronic electrocorticography procedures.
    Code 95836 has been intended to identify ECoG performed over a 30-day period, i.e. it identifies reporting for ongoing outpatient recording and interpretation of ECoG data after the patient has been discharged from the hospital. Note that this includes recording that uses electrodes that are placed in or on the brain with the intent of capturing electrocorticographic events/data over the course of a period of time that does not exceed 30 days. Review and interpretation of ECoG data usually occurs multiple times during the cycle in order to obtain a number of readings that may then be evaluated as parts of a total service. Therefore, this code should be reported only once during the 30-day period.
  • New codes have been added, existing codes revised, four codes deleted, and two new tables included in multiple sections of the CPT code set to clarify reporting cranial, cranial nerve, spinal, peripheral nerve, and sacral nerve neurostimulator services. In addition, several guideline revisions have been made to define existing neurostimulator programming and analysis services.

     

    95976	Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) 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/p>
    95977	Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) 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
    95983	Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) 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 (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) 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 (List separately in addition to code for primary procedure)

     

    Coinciding with the language revisions made to the guidelines are revisions to the codes themselves. These include: (1) addition of analysis parameters to the parent code 95970; (2)addition of physician/QHP as appropriate; (3) addition of language that specifies anatomy within the codes; (4) addition of new codes 95976-95977 and 95983-95984 to complement the existing codes by providing coding mechanisms for simple vs complex cranial nerve stimulation and time component reporting for brain neurostimulators; (5) deletion of codes 95974, 95975, 95978, and 95979 to accommodate the addition of the new codes; and (6) addition of exclusionary, add-on, and instructional parenthetical notes that restrict or direct reporting for these codes in congruity with the explanations provided within the guidelines for these services.

  • A new Adaptive Behavior Services subsection with new guidelines and eight new codes has been added. The new codes are categorized into two subsections within adaptive behavior services: (1) adaptive behavior assessments (97151, 97152); and (2) adaptive behavior treatments (97153-97158). These two subsections each have their own set of guidelines and definitions. Prior to 2019 adaptive behavior services were reported with Category III codes; (0359T-0361T; 0364T-0372T; 0362T-0363T; 0373T-0374T).

     

    Adaptive Behavior Assessments
    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
    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
    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
    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
    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

  • The Central Nervous System Assessments/Test (e.g. Neuro-Cognitive, Mental Status, Speech Testing) subsection has had substantial revisions. Specifically, codes 96101, 96102, 96103, 96111, 96118, 96119, and 96120 have been deleted; 12 codes (96112-96146) have been established to differentiate technician administration of neuropsychiatric testing from physician/psychologist administration and assessment of testing; addition and revision of guidelines; revision of the exclusionary parenthetical note following the Central Nervous System Assessments/Tests guidelines; and revisions to code 96116.

     

    Developmental/Behavioral Screening and Testing
    		Cognitive Services		Test Administration/Scoring		Interpretation and Report of Automated Result
    Code	Unit	Evaluation	Interactive Feedback	Physician or QHC Professional	Clinical Staff	Physician or QHC Professional	Automated Result
    96110	Per Instrument				x
    96112	Per Hour	x		x		x
    96113	Per Hour (add on)	x		x		x
    96127	Per Instrument				x

   

  Category III

  • Two new Category III codes (0512T, 0513T) have been established to report high-energy extracorporeal shock wave for integumentary wound healing. These two new codes are differentiated from other Category I codes for extracorporeal shock-wave treatment by the anatomy treated
    • 0512T Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; initial wound
    • 0513T Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; each additional wound (List separately in addition to code for primary procedure)
  • Code 0335T has been revised and two new codes (0510T, 0511T) have been added to better identify the insertion, removal, and removal and reinsertion services of a sinus tarsi implant device. An exclusionary parenthetical note has been added with instructions not to report code 0335T in conjunction with codes 28585, 28725, and 29907 (other talotarsal joint procedures)
    • 0510T Removal of sinus tarsi implant
    • 0511T Removal and reinsertion of sinus tarsi implant
  • Endovenous Arterial Revascularization Category III 0505T (New Code mid-year 2018)
    • Proprietary system to treat superficial femoral artery (SFA)-popliteal occlusions. Not FDA-approved, currently in clinical trials. (The procedure could be done with approved devices).
    • Percutaneous endovascular approach to bypass SFA-popliteal occlusions, particularly when heavily calcified
    • Access is gained antegrade into the SFA
    • Access is gained into the pedal vein toward the head
    • A crossing device is used to go out of the artery above the occlusion into the vein, passed through the venous lumen to below the level of the occlusion, then back into the artery below the occlusion
    • Stent grafts are placed from the artery above the occlusion, through the vein, and back into the artery below the occlusion
  • New code 0506T has been added to report macular pigment optical density measurement by heterochromatic flicker photometry, unilateral or bilateral, with interpretation and report.
  • Code 0507T has been added to report near0infrared dual imaging of meibomian glands.
  • Code 0508T see Radiology section of this document
  • Code 0509T has been added to describe pattern electroretinography (PERG). New guidelines and parenthetical notes have been added regarding the reporting of electroretinography (ERG) testing.
  • Code 0514T has been established to report intraoperative visual axis identification. This add-on code should be reported in conjunction with codes 66982 and 66984 (services related to removal of extracapsular cataract).
  • A new category III subsection titled “Wireless Cardiac Stimulation System for the Left Ventricular Pacing” and eight new category III codes with guidelines and parenthetical notes have been established to report insertion; removal, removal with replacement; interrogation; and programming for a wireless cardiac stimulator system (electrode, transmitter, and battery) used for resynchronization of the heart.

     

    Wireless Cardiac Stimulation System: LV Pacing
    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	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	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 (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

  • Code 0524T has been added to report endovenous catheter directed chemical ablation with balloon isolation of incompetent extremity vein. This endovenous ablation procedure differs from mechanical occlusion chemical ablation (36473, 36474) in that this procedure uses a balloon to isolate the incompetent vein from other veins in the deep system when delivering the embolizing or sclerosing agent.
  • Codes 0525T, 0526T, 0527T, 0528T, 0529T, 0530T, 0531T, and 0532T have been established to report intracardiac ischemia monitoring services.

     

    Intracardiac Ischemic Monitoring Services
    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	Programming device evaluation (in person) of 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
    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

     

  • Four new Category III codes (0533T, 0534T, 0535T, 0536T) have been established to report the use of a noninvasive movement-recording device, which quantifies kinematics of movement disorder symptoms, including bradykinesia, dyskinesia, and tremors, by continuously recording gross motor movement over an extended period.<
    • Code 0533T should be used to report set-up, patient training, configuration or monitor, data upload, analysis and initial report configuration, download review, interpretation and report.
    • The additional codes (0534T, 0535T, 0536T) are used to report specific aspects of the entire service. For example, if only the download review and interpretation and report is performed, then code 0536T should be reported.
  • A new subsection titled “Cellular and Gene Therapy,” new guidelines, and four new codes have been added to identify chimeric antigen receptor T cell (CAR-T) therapy services.

     

    Intracardiac Ischemic Monitoring Services
    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 (eg, cryopreservation, storage)
    0539T	Chimeric antigen receptor T-cell (CAR-T) therapy; receipt and preparation of CAR-T cells for administration
    0540T	Chimeric antigen receptor T-cell (CAR-T) therapy; CAR-T cell administration, autologous

     

  • Two new Category III codes (0541T, 0542T) have been established to report myocardial imaging by magnetocardiography (MCG).
    • Code 0541T describes a single MCG study using signal acquisition, generation of magnetic-field time-series images, quantitative analysis of magnetic dipoles, machine learning-derived clinical scoring, and automated report generation.
    • Code 0542T describes the work involved in interpreting and reporting the MCG study.

  Resources

  CPT and RBRVS 2019 Annual Symposium

  AMA CPT Changes 2019

  AMA CPT 2019