Big Coding Changes for 2019

Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

Advisor, APMA Coding Committee

Expert Panelist, Codingline

Advisor, APMA MACRA Task Force

Fellow, American Academy of Podiatric Practice Management

Board of Directors, American Society of Podiatric Surgeons

Board of Directors, American Professional Wound Care Association

Editorial Advisory Board, WOUNDS

Twitter: @DrLehrman

New ICD10 Codes Effective 10-1-18

F12.23 – Cannabis dependence with withdrawal

F12.93 – Cannabis use, unspecified with withdrawal

New ICD10 Codes Effective 10-1-18

G71.00 – Muscular dystrophy, unspecified

G71.01 – Duchenne or Becker muscular dystrophy

G71.09 – Other specified muscular dystrophies

M79.10 – Myalgia, unspecified site

New ICD10 Codes Effective 10-1-18

R93.89 – Abnormal findings on diagnostic imaging of other specified body structures

New ICD10 Codes Effective 10-1-18

T81.40X__ 7+ Infection following a procedure, unspecified

T81.41X__ 7+ Infection following a procedure, superficial incisional surgical site

T81.42X__ 7+ Infection following a procedure, deep incisional surgical site

T81.44X__ 7+ Sepsis following a procedure

T81.49X__ 7+ Infection following a procedure, other surgical site

Changes to Foot & Ankle Pertinent ICD-10 Codes

Effective October 1, 2018

G71.0- now requires a 5th character (Muscular Dystrophy)

M79.1- now requires a 5th character (Myalgia)

R93.8 – now requires a 5th character (Abnormal findings on diagnostic imaging

T81.4 – now requires a 5th character (Infection following a procedure)

Revisions to Foot & Ankle Pertinent ICD-10 Codes

Effective October 1, 2018

L98.495 Non-pressure chronic ulcer of skin of other sites with muscle involvement without evidence of necrosis

L98.496 Non-pressure chronic ulcer of skin of other sites with bone involvement without evidence of necrosis

L98.498 Non-pressure chronic ulcer of skin of other sites with other specified severity

CPT Changes Effective 1-1-19

Biopsy Codes Deleted CPT 11100 – Biopsy of skin, subcutaneous tissue and/or mucous

membrane (including simple closure), unless otherwise listed; single lesion

CPT 11101 - Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; each separate/additional lesion

Three New Sets of Biopsy Codes Tangential biopsy

Punch biopsy

Incisional biopsy

New Biopsy Codes CPT 11102 (Tangential biopsy of skin, (eg, shave, scoop, saucerize,

curette), single lesion)

CPT 11103 (Tangential biopsy of skin, (eg, shave, scoop, saucerize, curette), each separate/additional lesion)

New Biopsy Codes CPT 11104 (Punch biopsy of skin, (including simple closure when

performed), single lesion)

CPT 11105, (Punch biopsy of skin, (including simple closure when performed), each separate/additional lesion)

New Biopsy Codes CPT 11106, (Incisional biopsy of skin (eg, wedge), (including simple closure

when performed), single lesion)

CPT 11107 (Incisional biopsy of skin (eg, wedge), (including simple closure when performed), each separate/additional lesion)

Fine Needle Aspiration CPT 10021 – Fine needle aspiration; without imaging guidance

CPT 20612 – Aspiration and/or injection of ganglion cyst(s) any location

Fine Needle Aspiration ”Diagnostic procedure using a thin, hollow needle to percutaneously obtain

a sampling of cells for cytology exam or a sample of tissue for histological examination”.

Fine needle aspiration is a sampling that cannot otherwise be obtained using standard diagnostic techniques.

Fine needle aspiration examples Masses or nodules of the thyroid

Breast masses

Suspicious kidney growths

Biopsies of the lung.

1,000

Fine Needle Aspiration Old CPT 10021 - Fine needle aspiration without imaging guidance

CPT 10022 – Fine needle aspiration with imaging guidance

Fine Needle Aspiration New CPT 10021 - Fine needle aspiration biopsy, without imaging

guidance; without imaging guidancefirst lesion

CPT 10022 – Fine needle aspiration with imaging guidance DELETED

CPT 10004 Fine needle aspiration each additional lesion (List separately in addition to code for primary procedure)

Fine Needle Aspiration New CPT 10022 – Fine needle aspiration with imaging guidance DELETED

Replaced with codes for fine needle aspiration with ultrasound guidance flouroscopic guidance MR guidance CT guidance

Fine Needle Aspiration New CPT 10005 - Fine needle aspiration biopsy, including ultrasound

guidance; first lesion

CPT 10006 - each additional lesion (List separately in addition to code for primary procedure)

Fine Needle Aspiration New CPT 10007 - Fine needle aspiration biopsy, including fluoroscopic

guidance; first lesion

CPT10008 - each additional lesion (List separately in addition to code for

primary procedure)

Fine Needle Aspiration New CPT 10009 - Fine needle aspiration biopsy, including CT guidance; first

lesion

CPT 10010 - each additional lesion (List separately in addition to code for primary procedure)

Fine Needle Aspiration New CPT 10011 - Fine needle aspiration biopsy, including MR guidance; first

lesion

CPT 10012 - each additional lesion (List separately in addition to code for primary procedure)

New Bone Graft Codes CPT 20932 Allograft, includes templating, cutting, placement and internal

fixation, when performed; osteoarticular, including articular surface and contiguous bone (List separately in addition to code for primary procedure)

New Bone Graft Codes CPT 20933 Allograft, includes templating, cutting, placement and internal

fixation, when performed; hemicortical intercalary, partial (ie, hemicylindrical) (List separately in addition to code for primary procedure)

New Bone Graft Codes CPT 20934 Allograft, includes templating, cutting, placement and internal

fixation, when performed; intercalary, complete (ie, cylindrical) (List separately in addition to code for primary procedure)

Added intro language for skin sub codes (CPT 15271 – 15278)

Application of non-graft wound dressings are not separately reportable (eg, gel, powder, ointment, foam, liquid) or injected skin substitutes

The skin substitute graft codes may not be reported for powder application.

Deleted CPT 20005 - Incision and drainage of soft tissue abscess, subfascial (ie,

involves the soft tissue below the deep fascia)

Change in the definition of “home” for home E/M services:

“Home may be defined as a private residence, temporary lodging, or short term accommodation (eg, hotel, campground, hostel, or cruise ship).”

New CPT Codes CPT 99451 - Interprofessional telephone/Internet/electronic health record

assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time

CPT 99452 - Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes

New CPT Codes CPT 99453 - Remote monitoring of physiologic parameter(s) (eg, weight,

blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment

CPT 99454 - Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days

New CPT Codes CPT 99457 - Remote physiologic monitoring treatment management

services, 20 minutes or more of clinical staff/physician/ other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month

New Cat III Codes 0512T - Extracorporeal shock wave for integumentary wound healing, high

energy, including topical application and dressing care; initial wound

0513T - each additional wound (List separately in addition to code for primary procedure)

Cat III Code Revision Cat III 0101T (Extracorporeal shock wave involving musculoskeletal

system, not otherwise specified, high energy) adds designation that it is not for integumentary procedures

Cat III 0335T revised - Insertion of sinus tarsi implant Extra-osseous subtalar joint implant for

talotarsal stabilization

New Cat III Codes 0510T - Removal of sinus tarsi implant

0511T - Removal and reinsertion of sinus tarsi implant

Thank You!!

Big Coding Changes for 2019

Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

Advisor, APMA Coding Committee

Expert Panelist, Codingline

Advisor, APMA MACRA Task Force

Fellow, American Academy of Podiatric Practice Management

Board of Directors, American Society of Podiatric Surgeons

Board of Directors, American Professional Wound Care Association

Editorial Advisory Board, WOUNDS

Twitter: @DrLehrman