Among the upcoming changes to the CPT code set are updates to the radiology codes and medicine sections. This article discusses those updates, which take effect for all claims submitted on or after Jan 1.
New CPT code
Revised CPT code
Resequenced CPT code
Designated add-on CPT code
Radiology
Many “radiologic exam” radiology codes were revised, including 74022, 74210, 74220, 74230, 74240, 74246, 74250, 74270 and 74280. In addition, the following new radiology codes were added under “radiologic examination.”
74221Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study
74248 Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed with small intestine follow-through study, including multiple serial images (Use 74248 in conjunction with 74240, 74246)
Updates also were made to myocardial imaging. Radiology Codes 78459, 78491 and 78492 were revised. New codes include:
78429 Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall motion(s), and/or ejection fraction(s), when performed) single study; with concurrently acquired computed tomography transmission scan
78430 Myocardial imaging, PET, perfusion study (including ventricular wall motion(s), and/or ejection fraction(s), when performed); single study, at rest or stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan
78431 multiple studies at rest and stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan
78432 Myocardial imaging, positron emission tomography, combined perfusion with metabolic evaluation study (including ventricular wall motion(s), and/or ejection fraction(s), when performed), dual radiotracer (eg, myocardial viability)
78433 with concurrently acquired computed tomography transmission scan
Radiology Codes 74241, 74245, 74247, 74249 and 74260 will be deleted.
Emergency Medicine
Electroencephalogram (EEG)
Emergency Medicine Codes 95813 was revised from “greater than 1 hour” of EEG extended monitoring to “61-119 minutes.”
Emergency Medicine Codes 95950, 95951, 95953 and 95956 were deleted. To report, see 95700-95726.
Emergency Medicine Codes 95827 was deleted. To report all night EEG recording, see 95705-95707, 95711-95713, 95717, 95718.
Additions include the following:
95700 Electroencephalogram (EEG) continuous recording, with video when performed, set-up, patient education, and take down when performed, administered in-person by EEG technologist, minimum of 8 channels.
New Emergency Medicine codes were added for professionals who can bill independently but are not allowed to bill for evaluation and management (E/M) services (e.g., licensed clinical social worker, physical therapist).
- Report once for the qualified nonphysician health care professional’s cumulative time during a seven-day period.
- Time begins with the qualified nonphysician health care professional’s initial, personal review of the patient-generated inquiry.
- Do not report the online digital service if:
- It is within seven days of a previous treatment or service, and services are related.
- It is within the postoperative period of a previously completed procedure.
If the patient presents with a new, unrelated problem during the seven-day period of an online digital E/M service, then the qualified nonphysician health care professional’s time spent on the E/M of the additional problem is added to the cumulative service time of the online digital E/M service for that seven-day period.
98970Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
98971 11-20 minutes
9897221 or more minutes
Code 98969 (online assessment and management by other qualified health care professional) was deleted.
Health and Behavioral Assessment and Intervention
New codes were created for this service to combine assessment and re-assessment (96156) and provide add-on codes for time-based reporting for the intervention services. New guidelines also clarify that these codes should be billable on the same day as an E/M service so long as the providers are different. These codes are not reported by physicians or providers who may bill for an E/M service. CPT also clearly defines assessment vs. intervention.
96156Health behavior assessment or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)
96158Health behavior intervention, individual, face-to-face; initial 30 minutes
96159 each additional 15 minutes (Report with 96158)
96164 Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes
96165 each additional 15 minutes (Report with 96164)
96167 Health behavior intervention, family (with the patient present), face-to-face; initial 30 minutes
96168 each additional 15 minutes (Report with 96167)
96170 Health behavior intervention, family (without the patient present), face-to-face; initial 30 minutes
96171 each additional 15 minutes (Report with 96170)
Codes 96150-96155 have been deleted.
Therapeutic procedures
New codes were added for therapeutic interventions with a focus on cognitive functions. These replace 91727 (which will be deleted) and are time-based. Code 97129 is reported only once per day.
97129Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes
97130 each additional 15 minutes
For More Information: coding120319