Finish Your CPT® 2019 Overview With Lab to E/M: Part 3


We’re in the home stretch of our first look at CPT® 2019! Let’s finish strong. Here’s Part 3, the last post in our series on new five-digit Category I CPT® 2019 codes.

Don’t forget: Part 1 covers FNA to cardiovascular surgery, and Part 2 covers lymph node biopsy to breast MRI. This is just a quick overview of expected changes and doesn’t include Cat. III or PLA. You’ll need an official version of the codes and guidelines to use when the code set is effective on Jan. 1, 2019, to be sure you have the most up-to-date version of these procedure codes.

Dig Through Dozens of Lab Additions

The path/lab section of CPT® may have about 50 new codes for 2019. Gene analysis makes up the bulk of the expected additions, such as 81163 for BRCA1 and 81345 for TERT. Check for revisions and deletions related to this long list of changes, too. For instance, for BRCA1 and BRCA2, codes 81162, 81212, and 81215-81217 will be revised, while 81211, 81213, and 81214 will be deleted. (If you code for path/lab, check out Pathology/Lab Coding Alert for analysis of the updates specific to your specialty.)

Here are a few more new codes to watch for:

  • Expect to see 81443 for genetic testing for severe inherited conditions. The test must include at least 15 genes for the code to apply.
  • Breast oncology mRNA gene expression profiling will have a new code at 81518 for 11 genes.
  • For chronic hepatitis C, you’ll have 81596. The result is “reported as scores for fibrosis and necroinflammatory activity in liver.”
  • In the Chemistry Procedures section, watch for 82642 for dihydrotestosterone (DHT) and 83722 for small dense LDL cholesterol.

Know What’s New for Vaccine Coding

If you administer flu vaccines, don’t miss new code 90689 (Influenza virus vaccine, quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use). You can find more information about this code in CMS MLN Matters MM10871.

Separate New Electroretinography Options

Electroretinography coding is getting a little more specific with new codes 92273 (for full field) and 92274 (for multifocal). Because you’ll have these new codes, expect existing code 92275 to be deleted.

Plan Ahead for Pulmonary Artery Pressure Monitoring Change

Plan for 93264 for remote monitoring of a wireless pulmonary artery pressure sensor. You’ll want to be sure you check all the requirements for the code, such as covering up to 30 days, a minimum of weekly downloads, and interpretation, to name a few.

Expect a Neurostimulator Coding Overhaul

If you report services related to neurostimulators, watch for big changes. Here’s a quick rundown so you know where to look in the code set:

  • Electrocorticogram, up to 30 days (new code 95836)
  • Electronic analysis of implanted neurostimulator pulse generator/transmitter (new codes 95976, 95977, 95983, 95984; revised codes 95970-95972; deleted codes 95974, 95975, 95978, 95979).

Don’t Miss Developmental and Psychological Testing News

In a dozen new testing codes, pay attention to the descriptor to see who needs to perform the service for you to report it:

  • By a physician or other qualified healthcare professional
    • Developmental test admin (96112, 96113)
    • Neurobehavioral status exam (96121)
    • Psychological testing evaluation services (96130, 96131)
    • Neuropsychological testing evaluation services (96132, 96133)
    • Psychological or neuropsychological test administration and scoring (96136, 96137)
  • By technician
    • Psychological or neuropsychological test administration and scoring (96138, 96139)
  • Automated
    • Psychological or neuropsychological test administration (96146).

Base Many of These Behavioral Health Codes on Provider

For behavior identification assessment and adaptive behavior treatment, be sure you’re aware of these new options:

  • Behavior identification assessment by physician/other qualified healthcare professional (97151) or tech under direction (97152)
  • Adaptive behavior treatment by physician/other qualified healthcare professional (97155) or tech under direction (97153)
  • Group adaptive behavior treatment by physician/other qualified healthcare professional (97158) or tech under direction (97154)
  • Family adaptive behavior treatment by physician/other qualified healthcare professional (97156)
  • Multi-family adaptive behavior treatment without patient present by physician/other qualified healthcare professional (97157).

Important: Review the complete descriptors of the new codes to be sure you understand requirements. For instance, protocol modification is included in many of the physician codes.

Review New Codes for Remote and Management E/M Services

The big news for E/M in 2019 may be Medicare payment if 2019 proposed MPFS changes go through. But there are some new codes planned, too:

  • Remote physiologic monitoring (99453, 99454) and remote physiologic monitoring treatment management (99457)
  • Interprofessional phone, internet, EHR assessment and management (99451), and referral service (99452)
  • Chronic care management that a physician or other qualified healthcare professional personally provides for a patient at significant risk (99491).

What About You?

Our focus here was code additions for AMA CPT® 2019. Do you tend to find code descriptor revisions trickier than new codes because they change how you use codes you’ve used before?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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