Part 1: What Does the MPFS Proposed Rule Reveal About CPT® 2018?

2018 updates

When the Medicare Physician Fee Schedule Proposed Rule comes out, it includes discussions of how to value new codes, and it’s fun to look for insights into the procedure codes that will be coming our way. Let’s take a quick tour of what’s expected for CPT® 2018 based on what’s in the pages of the MPFS proposed rule.

Note: The proposed codes mentioned, such as 32xxx, are placeholder codes like the ones AMA and CMS use to suggest where the code will be in the code set if the code is finalized.


Five new anesthesia codes for gastrointestinal endoscopic procedures appear to be in the works, two for upper, two for lower, and one for combined.

Expect deletion of 00740 (upper GI) and 00810 (lower intestine) to make room for the new codes.


Watch for new flap codes, one for midface, and one for head and neck with a named vascular pedicle. These will replace current head and neck flap code 15732 to better fit the work performed for head and neck cancer patients based on site.

Placing a radiation therapy applicator concurrent with partial mastectomy will also likely have a new code in the Integumentary section (192xx).


If you report spine surgery related to bone marrow aspiration for bone grafting, you can expect a new code to learn (2093x).

Respiratory System

Nasal/sinus endoscopy looks set to pick up five new codes (31xxx). They represent bundled services frequently reported together. For example, the proposed code expected to have the highest work RVUs (9.00) covers nasal/sinus endoscopy with ethmoidectomy, including frontal sinus exploration and tissue removal.

Also, you can expect percutaneous cryoablation of pulmonary tumors to move from Category III (0340T) to Category I (32xxx).

Cardiovascular System

Total replacement heart systems appear to have three new codes (339xx): implant, remove and replace, and remove for heart transplant. CPT® 2018 plans to delete 0051T-0053T to make way for the new codes.

Vascular coders need to start warming up for these changes now:

  • Eleven proposed codes (34xxx) specifically refer to endovascular repair of infrarenal aorta and iliacs, and five more cover endograft fixation and artery access.
    • Tip: The Sept./Oct. 2016 CPT® Editorial Summary of Panel Actions notes the deletion of many existing 348xx codes and related codes as part of this update.
  • Two proposed codes (364xx) apply to endovenous ablation therapy by chemical adhesive, and two more apply to foam sclerosant injection.

Hemic and Lymphatic

Diagnostic bone marrow services may see an interesting change as 38220 (aspiration) and 38221 (biopsy) will likely be joined by a new code that represents both biopsy and aspiration.

Another new code (3857x) proposed in this section applies to laparoscopic procedures with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling. Specific services listed include peritoneal washings and biopsy, omentectomy, and diaphragmatic washings.

Digestive System

Three esophagectomy proposed codes (432xx) that include laparoscopic and thoracoscopic services should reduce the number of unlisted procedure codes you need to report.

Male Genital System

In place of 0438T, you may have a new Category I code (55×87) for peri-prostatic, transperineal placement of biodegradeable material.

Female Genital System

Watch for a new laparoscopic total hysterectomy code (5857x) that applies when the service involves tumor debulking with omentectomy.

Stay Tuned …

Watch for Part 2 to cover nervous system, radiology, medicine, and E/M section changes. Which updates are you most interested in learning 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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