CPT 2018 Update Brings New E/M Codes, Mass Revisions and Revised Guidelines

September 2017 ~

A total of 314 code changes have been implemented throughout the 2018 CPT manual. These changes include 172 new codes, 60 revised codes, and 82 deleted codes. The changes include updates ranging from revised observation visits in the evaluation and management (E/M) chapter to new photodynamic therapy services in the Medicine chapter and two new modifiers, as well as revised guidance and clarifications to help report initial observation care and prolonged services.

Of these changes, Anesthesia will see four changes to observation E/M codes, the addition of five gastro-endoscopic procedure codes, and three low-volume codes have been deleted. A summary of these code changes can be seen below:

Code Changes

• Cognitive-Assessment Services: report 99483 in place of G0505.
  • 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.
• Collaborative Care Management (CoCM) services: report 99492, 99493 and 99494 in place of G0502, G0503 and G0504.
  • 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.
• Care Management-Focused Behavioral Health Integration (BHI): report 99484 in place of G0507.
  • 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.

As well, four slight changes have been made to the verbiage of one discharge and three initial observation care E/M codes. Codes 99217, 99218, 99219, 99220 have been updated to include the term “outpatient hospital” to describe the observation status in question.

New Codes

Five codes for anesthesia for gastro-endoscopic procedures added.

• 00731 – Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified.
• 00732 – Endoscopic retrograde cholangiopancreatography [ERCP].
• 00811 – Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified.
• 00812 – Screening colonoscopy.
• 00813 – Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum.

Deleted Codes

Four Anesthesia service codes will be deleted due to the low volume of the procedure.

• 01180 – Extrapelvic.
• 01190 – Intrapelvic.
• 01682 – Obdurator neurectomy and shoulder cast application, removal or repair; shoulder spica.

For complete details regarding these changes, refer to CMS’ CY 2018 Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B page.

Source(s): CMS; DecisionHealth; American Medical Coding; Super Coder;