CPT 2018 Summary of Changes

CPT changes go into effect on 1/1/2018. A few highlights for frequently used categories are noted below. Please refer to the spreadsheet link here to review all code additions, deletions and revisions. The spreadsheet includes a summary tab and additional tabs separated by specialty. For ease of review, the code change category is noted in Column A.

Radiology
CPT codes 71010-71035 for x-ray of chest are being deleted and replaced with the following four CPT codes and are reported based on the number of views:

  • 71045 (Radiologic examination, chest; single view).
  • 71046 (Radiologic examination, chest; 2 views).
  • 71047 (Radiologic examination, chest; 3 views).
  • 71048 (Radiologic examination, chest; 4 or more views)

X-rays of the abdomen will undergo similar changes; CPT codes 74000-74020 will be deleted and replaced by the following three codes:

  • 74018 (Radiologic examination, abdomen; 1 view).
  • 74019 (Radiologic examination, abdomen; 2 views).
  • 74021 (Radiologic examination, abdomen; 3 or more views).

Revisions to ultrasound exams:
Descriptors instruct you to report a complete service when the provider examines the joint space and the surrounding soft tissues and to report a limited service when the exam involves a joint space or surrounding soft tissues such as tendons or nerves as demonstrated in the following two codes:

  • 76881 Ultrasound, extremity, nonvascular, complete joint (ie, joint space and peri-articular soft tissue structures) real-time with image documentation; complete.
  • 76882 Ultrasound, limited, anatomic specific joint or other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft tissue structure[s], or soft tissue mass[es]), real-time with image documentation.

Evaluation and Management Services
Revisions:

  • Outpatient hospital was added to the descriptor of four observation E/M codes: 99217-99220. This change in verbiage helps clarify that observation services are considered outpatient and not inpatient

New codes added:

  • 99483 (Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home).

Code 99483 requires 10 reporting elements. In addition the full CPT description of code 99483 provides some clarity on the amount of time that is expected when billing this code. “Typically, 50 minutes are spent face-to-face with the patient and/or family or caregiver.”
99492 (Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional).

  • 99493 (Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities).
  • 99494 (Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities).
  • 99484 (Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month).

Anesthesia

Codes for anesthesia for gastro-endoscopic procedures added 00731, 00732, 00811, 00812 and 00813. The following anesthesia codes were deleted: 00740, 00810, 01180, 01190 and 01682.

Two additional flu-vaccine codes become effective in 2018

  • 90756 (Influenza virus vaccine, quadrivalent [ccIIV4], derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use).
  • 90682 (Influenza virus vaccine, quadrivalent [RIV4], derived from recombinant DNA, hemagglutinin [HA] protein only, preservative and antibiotic free, for intramuscular use).
    These codes may sound familiar as Part B News has already released guidance for how to bill them. Both codes are related to quadrivalent injections.

There are many more changes as outlined in the spreadsheet, so be sure to review all that pertain to your practice.