The 2018 changes to the CPT® codes include many that cover internal medicine. Office and practice managers, coders and billers need to be aware of these changes and integrate them into their practices.
Internal medicine CPT® codes for 2018 include a new section of diagnosis codes for tobacco use disorders, new diabetes Type II codes with ketoacidosis classifications, and diagnosis codes for substance use disorders, including sections on alcohol, opioids and cannabis.
Jill Young, principal of Young Medical Consulting, outlines the changes in detail in a conference for ProfEdOnDemand, “2018 CPT Coding Updates for Internal Medicine.”
E/M Code Changes
For evaluation and management (E/M) services, there are changes to Observation Codes 99217-9920, guidelines for domiciliary, rest home or custodial care services and revised guidelines for prolonged service with direct patient contact.
The big news here is a new section, with new guidelines and new code, for cognitive assessment and care plan services:
- 99483 reports patient assessment and care planning
- Ten elements must be met to report the code—and if they aren’t, an E/M service should be reported
- Codes can’t be reported more than once per 180 days, and don’t report if any of the required elements are not performed or deemed necessary
- Services are given when a comprehensive evaluation of a new or existing patient exhibiting signs and symptoms of cognitive impairment is needed to establish or confirm a diagnosis, etiology and condition severity
- Service includes a thorough evaluation of medial and psychosocial factors
- Medical decision-making includes current and likely disease progressions and an assessment of the need to refer the patient for rehab, social, legal, financial or community-based services
These are just a handful of the major code updates, Young said. Other major sectional changes were announced for:
- Home and Outpatient Normalized Ratio monitoring services
- Pulmonary diagnostic testing and therapies
- Psychiatric collaborative care management services
- General behavioral health integration management
- Emergency department time
- Chest x-rays
Chapter-specific codes were updated for chapters 2 (neoplasms), 4 (endocrine, nutritional and metabolic diseases), 7 (diseases of the eye and adnexa), 9 (diseases of the circulatory system), 12 (diseases of the skin and subcutaneous tissue), 13 (diseases of the musculoskeletal system and connective tissue), 20 (external causes of morbidity), 21 (factors influencing health status and contact with health services) and section IV (diagnostic coding and reporting guidelines for outpatient services).
Updates to the ICD-10-CM Official Guidelines for Coding and Reporting went into effect Oct. 1. There is a new category and new codes for mast cell neoplasm of uncertain behavior and revised or added codes for congenital malformations of the skin. Diabetes mellitus has a new subcategory with new codes and there are new codes for amyloidosis.
Get a Full Run-Down from an Expert in the Field
Young, who has more than 30 years of medical experience working in all areas of codding, including clinical, billing and rounding with physicians, packed her updates into a 60-minute overview. The session agenda also covers how the use of invalid or corrected internal medicine codes can lead to reduced, delayed or denied payments, how a practice can be impacted by CPT® code changes and why staff need to start applying the updated codes at once.
