If you’re anxiously awaiting the release of the latest CPT® code updates, you’re not alone. The updates, typically released in September, will take effect January 1st, 2020. That gives you plenty of time to study and implement the CPT® that affect your practice and/or specialty. So what’s on the horizon? We don’t yet know for sure, but the discussion at the most recent meeting of the CPT® Editorial Panel in February 2019 should provide some clues.
Big Changes Ahead for E/M Codes
E/M codes (99201-99215) have been on the table for revision for a while now. Last year, CMS proposed a dramatic overhaul, proposing a flat fee for codes 99202-99205 and 99212-99215. That proposal didn’t take effect—in fact, it was delayed until 2021. Here’s a sampling of what’s supposed to go down:
- History and examination are no longer key components for choosing the level of E/M service.
- Requirement added that a medically appropriate history and/or exam must be performed in order to report codes 99202-99215.
- The basis of code selection will be either the level of medical decision making (MDM) or total time spent during the visit.
- The definition of the time element will change from “face-to-face” time to “total time spent on the day of the encounter.” The amount of time associated with each code will also be revised.
- Prolonged services guidelines will be revised, to include the addition of code 99XXX to report prolonged office or other outpatient E/M service.
So what’s the bottom line? Practice that currently bill a lot of level four and five codes may see reductions in reimbursement, while those that currently bill a higher number of lower level codes could see increases. Overall, the documentation requirements should be lighter, but that could also make it difficult to meet quality measures that are documentation-dependent.
2020 Brings New Gene Sequencing Codes
While nothing is finalized, the CPT® Editorial Panel meeting summary gives a peek at several new CPT® updates that include:
- Codes 813X1 and 813X2 to report the analysis of PALB2 (full gene sequence). PALB2 stands for “partner and localizer of BRCA2” and a mutation in this gene can signal an increased risk of breast cancer. Code 81406 has been revised to report PALB2 testing.
- Code 8XX01 to report analysis of PIK3CA. A mutation of this gene occurs in 15-30 percent of breast, endometrial, and colon cancers, and is associated with a poor prognosis and lack of response to certain therapies in patients with those types of cancer.
- Category III code 0X10T to report an assay of cancer stem cell cytotoxicity.
Category III Temporary Codes on the Table
Category III codes are a temporary set of codes used for new technologies. They allow for data collection to either “substantiate widespread usage” or to “provide documentation for the FDA approval process. For 2020, possible new CPT® updates to Category III codes include:
- 05X0T to report evacuation of Meibomian glands.
- 05X1T and 05X2T to report transcervical bilateral fallopian tube occlusion. Also includes the separate use of saline to confirm occlusion.
- 05X3T and 05X4T to report autologous adipose tissue cellular implant.
Along with these additions, the panel approved the archiving of several Category III codes.
Other Additions Could Take Effect in 2020
The CPT® panel has approved several other new codes to take effect on January 1, 2020, including:
- 906X5 to report a quadrivalent inactivated–adjuvanted influenza virus vaccine.
- 946X0 to report an exercise test for bronchospasm
While you’ll have to wait until later this fall to know specifically what CPT® code changes will affect your practice, it pays—literally—to know what’s on the horizon.