Part 1: Prepare for CPT® 2020 for E/M and Surgery Codes

The 2020 CPT® code set includes 394 code changes, with 248 new codes, 71 deletions, and 75 revisions, according to the AMA. Let’s start learning those changes by going over what’s new in Category I for E/M and Surgery section codes.

Expect Remote and Online to Dominate E/M Changes

You probably know there will be big changes for 2021 office/outpatient visit E/M code descriptors. But there’s some E/M news for 2020, too.

First, you’ll have new online digital E/M codes 99421-99423 in place of single online E/M code 99444.

Here are the major pointers for the new codes:

  • Each code describes an online digital E/M service
  • The service must be for an established patient
  • Each code covers 7 days
  • You’ll choose the code based on cumulative time during those seven days
  • Use 99421 for 5-10 minutes, 99422 for 11-20 minutes, and 99423 for 21 or more minutes
  • These codes are out of numerical sequence.

Related 98xxx codes: The 2020 CPT® code set will also add new codes 98970-98972 that are like 99421-99423, but you’ll use the 98xxx codes for services by a “Qualified nonphysician health care professional,” according to the descriptor. The 2020 proposed rule for revisions to the Medicare Physician Fee Schedule states that the 98xxx codes are for practitioners who can’t bill E/M services independently, and the CPT® guidelines list the examples of speech-language pathologists, physical therapists, occupational therapists, social workers, and dietitians. Medicare plans to create separate G codes (HCPCS) that refer to “assessment” rather than “evaluation and management” for you to use in place of the 98xxx codes when reporting for Medicare beneficiaries.

BP measuring: The 2020 code set also will include two new codes for “Self-measured blood pressure using a device validated for clinical accuracy.” You’ll use 99473 for patient education and calibrating the device. You’ll use 99474 for collecting data reported by the patient/caregiver, a report of average systolic and diastolic pressures, and communicating the treatment plan to the patient.

Remote monitoring: CPT® 2019 added 99457 for 20 minutes or more of remote physiologic monitoring treatment management services in a month. The 2020 code set revises the code to apply to the first 20 minutes and adds +99458 for each additional 20 minutes.

Which Surgery Section Changes Affect You Most?

The Surgery section of CPT® covers a lot of areas, from skin grafting to cataract removal. Here are the highlights:

  • Grafting: Watch for four new codes for grafting of autologous fat harvested by liposuction, 15771-15774. The codes vary based on the amount of injectate and the grafting site. The 2020 code set also deletes 20926 for other tissue grafts, but it adds 15769 (Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia)).
  • Needle insertions: Dry needling will have two new codes with 20560 (1-2 muscles) and 20561 (3 or more muscles) representing needle insertion without injection.
  • Drugdelivery devices: There will be six new add-on codes, +20700-+20705, related to drug-delivery devices. Three codes are for manual preparation and insertion, varying based on deep, intramedullary, or intra-articular placement. There will be three additional codes for removal based on those same locations. Report these codes along with the appropriate primary surgical procedure.
  • Chest wall tumor excision: Move your search for chest tumor excision codes from 19260, 19271, and 19272 (all deleted for 2020) to new codes 21601-21603.
  • Nasal/sinus endoscopy: Several nasal/sinus endoscopy codes will carry the triangle symbol that indicates a revision for 2020. The AMA reworked the descriptors so the codes can be arranged into more specific families. For instance, 31295-31298 will no longer have just “Nasal/sinus endoscopy, surgical” before the semicolon in the descriptor. Instead, they all will start with the phrase “Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation)” before the semicolon.
  • Pericardial services: The 2020 code set will replace pericardiocentesis codes 33010 and 33011 with 33016, which includes any imaging guidance. Code 33015 for tube pericardiostomy also will be gone. In 2020, watch for pericardial drainage codes 33017-33019.
  • Pacemaker removal: A revision to 33275 brings the existing guideline that the code includes imaging guidance into the descriptor for this leadless pacemaker removal code.
  • Aortic arch grafts: Ascending aorta graft code 33860 will be replaced by 33858 (for aortic dissection) and 33859 (not for dissection). In place of 33870, watch for more detailed code 33871 (Transverse aortic arch graft, with cardiopulmonary bypass, with profound hypothermia, total circulatory arrest and isolated cerebral perfusion with reimplantation of arch vessel(s) (eg, island pedicle or individual arch vessel reimplantation)).
  • Endovascular repair: CPT® 2020 will delete 0254T for iliac artery bifurcation endovascular repair. But you will have +34717 and 34718 for deployment of an iliac branched endograft. You’ll use +34717 as an add-on code with iliac endovascular repair codes 34703-34706. Code 34718 will be a standalone code for iliac repair “not associated with placement of an aorto-iliac artery endograft at the same session.”
  • Artery exploration: If you report artery exploration without surgical repair, get ready to update your code options. You’ll still have 35701, but it will change from carotid only to cover any neck artery, with carotid and subclavian given as examples. You’ll also have 35702 for the upper extremity and 35703 for lower extremity services. Codes 35721 (femoral), 35741 (popliteal), and 35761 (other) will be deleted.
  • Hemorrhoidectomy: Internal hemorrhoidectomy coding will see some changes for 2020. Ligation codes 46945 and 46946 will have the phrase “without imaging guidance” added to the descriptors. A new code, 46948, provides a specific option for transanal dearterialization of two or more hemorrhoid columns or groups, including ultrasound guidance.
  • Pelvic packing: You’ll have new codes for preperitoneal pelvic packing with exploration (49013) and re-exploration of the wound with packing removal and any repacking (49014).
  • Orchiopexy: Code 54640 has been a source of confusion for years. Before 2020, the descriptor referred to inguinal orchiopexy with or without hernia repair, suggesting the code included hernia repair. But CPT® guidelines instructed you to report the services separately: “For inguinal hernia repair performed in conjunction with inguinal orchiopexy, see 49495-49525.” The 2020 code set keeps that guideline to report the services separately and clarifies the descriptor by removing the hernia reference: “Orchiopexy, inguinal or scrotal approach.”
  • Spinal puncture: There will be an imaging guidance update for spinal puncture. You’ll still have 62270 (lumbar diagnostic) and 62272 (therapeutic), but you’ll also have new options 62328 and 62329 for when those services respectively use fluoroscopic or CT guidance.
  • Nerve injection: Coders who report nerve injections will want to take a close look at the long list of changes noted throughout 64400-64454. The major update is that the descriptor wording before the semicolon changes from “Injection, anesthetic agent” to “Injection(s), anesthetic agent(s) and/or steroid.” This change affects every code in that code family. Some of the codes within the code family will see individual updates, such as deletion of 64402 (facial nerve), 64410 (phrenic nerve), and 64413 (cervical plexus). Watch for these revisions, too:
    • Code 64400 will change from “trigeminal nerve, any division or branch” to “trigeminal nerve, each branch (ie, ophthalmic, maxillary, mandibular)”
    • Codes 64415 (brachial plexus), 64445 (sciatic nerve), and 64447 (femoral nerve) will remove “single” from their descriptors
    • Code 64420 will add “level” to become “intercostal nerve, single level”
    • Code 64421 will become an add-on code for 64420 and change from “multiple, regional block” to represent “each additional level”
    • There will be two new codes, 64451 for “nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)” and 64454 for “genicular nerve branches, including imaging guidance, when performed.”
  • Nerve destruction: The sacroiliac (SI) joint and genicular nerves mentioned above get additional attention in two more new codes. You’ll use 64624 for genicular nerve branch destruction by neurolytic agent, including imaging guidance if used. And you’ll use 64625 for radiofrequency ablation of nerves innervating the SI joint, with imaging guidance.
  • Ciliary body destruction: Code 66711 will add “without concomitant removal of crystalline lens” to the end of the current descriptor, “Ciliary body destruction; cyclophotocoagulation, endoscopic.” When there is lens removal, CPT® directs you to new codes 66987 and 66988, described below.
  • Cataract removal: Cataract removal code 66984 and complex removal code 66982 will each have “without endoscopic cyclophotocoagulation” added to the ends of their descriptors. This change makes room for the addition of 66987 (complex) and 66988 for the removal procedures with endoscopic cyclophotocoagulation.

What About You?

Which of these changes are you most interested in learning more about? Many of them come with changes to guidelines, as well. We still have several sections to cover in our CPT® 2020 update overview, so be sure to check out Part 2 and Part 3.

About 

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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