![Page 1: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/1.jpg)
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
![Page 2: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/2.jpg)
New ICD10 Codes Effective 10-1-18
F12.23 – Cannabis dependence with withdrawal
F12.93 – Cannabis use, unspecified with withdrawal
![Page 3: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/3.jpg)
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
![Page 4: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/4.jpg)
New ICD10 Codes Effective 10-1-18
R93.89 – Abnormal findings on diagnostic imaging of other specified body structures
![Page 5: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/5.jpg)
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
![Page 6: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/6.jpg)
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)
![Page 7: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/7.jpg)
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
![Page 8: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/8.jpg)
CPT Changes Effective 1-1-19
![Page 9: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/9.jpg)
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
![Page 10: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/10.jpg)
Three New Sets of Biopsy Codes Tangential biopsy
Punch biopsy
Incisional biopsy
![Page 11: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/11.jpg)
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)
![Page 12: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/12.jpg)
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)
![Page 13: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/13.jpg)
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)
![Page 14: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/14.jpg)
Fine Needle Aspiration CPT 10021 – Fine needle aspiration; without imaging guidance
CPT 20612 – Aspiration and/or injection of ganglion cyst(s) any location
![Page 15: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/15.jpg)
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.
![Page 16: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/16.jpg)
Fine needle aspiration examples Masses or nodules of the thyroid
Breast masses
Suspicious kidney growths
Biopsies of the lung.
![Page 17: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/17.jpg)
1,000
![Page 18: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/18.jpg)
Fine Needle Aspiration Old CPT 10021 - Fine needle aspiration without imaging guidance
CPT 10022 – Fine needle aspiration with imaging guidance
![Page 19: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/19.jpg)
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)
![Page 20: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/20.jpg)
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
![Page 21: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/21.jpg)
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)
![Page 22: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/22.jpg)
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)
![Page 23: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/23.jpg)
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)
![Page 24: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/24.jpg)
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)
![Page 25: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/25.jpg)
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)
![Page 26: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/26.jpg)
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)
![Page 27: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/27.jpg)
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)
![Page 28: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/28.jpg)
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.
![Page 29: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/29.jpg)
Deleted CPT 20005 - Incision and drainage of soft tissue abscess, subfascial (ie,
involves the soft tissue below the deep fascia)
![Page 30: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/30.jpg)
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).”
![Page 31: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/31.jpg)
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
![Page 32: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/32.jpg)
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
![Page 33: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/33.jpg)
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
![Page 34: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/34.jpg)
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)
![Page 35: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/35.jpg)
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
![Page 36: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/36.jpg)
Cat III 0335T revised - Insertion of sinus tarsi implant Extra-osseous subtalar joint implant for
talotarsal stabilization
![Page 37: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/37.jpg)
New Cat III Codes 0510T - Removal of sinus tarsi implant
0511T - Removal and reinsertion of sinus tarsi implant
![Page 38: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/38.jpg)
Thank You!!
![Page 39: Big Coding Changes for 2019 Changes ICD10 and CPT... · 2019-01-24 · Big Coding Changes for 2019 Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC Advisor AP, MA Coding Committee . Expert](https://reader030.vdocument.in/reader030/viewer/2022040511/5e5d37d101b5e718d7191979/html5/thumbnails/39.jpg)
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