The 2018 CPT® manual includes a total of 314 code changes ranging from revised observation visits in the E/M chapter to new photodynamic therapy services in the Medicine chapter—and two new modifiers. Physicians, midwives, clinical nurse specialists, coders, billers, office managers and clinical staff need to be aware of the changes.
In all, 2018 presents 172 new codes and 60 revised codes, plus 82 deleted codes, said Lori-Lynne A. Webb, who has been involved in specialty coding for more than 20 years and recently explained the changes in a conference for ProfEdOnDemand, “2018 CPT, ICD-10 & HCPCS Updates for Obstetrics-Gynecology.”
Coding Details Pivot
The pivot from HCPCS to CPT® includes five new codes, Webb said:
- For cognitive-assessment services, report 99483instead of G0505
- For collaborative care management services, report 99492, 99493 and 99494instead of G0502, G0503 and G0504
- For care management-focused behavioral health integration, report 99484, notG0507
Webb noted additional details were added to codes 99483 (assessment of and care planning for a patient with cognitive impairment), 99492 (initial psychiatric collaborative care management), 99493 (subsequent psychiatric collaborative care management), 99494 (initial or subsequent psychiatric collaborative care management), and 99484 (care management services for behavioral health conditions).
The new cognitive-assessment code, 99483, requires 10 reporting elements—just as G0505 did in 2017. However, said Webb, the full CPT® description of the code clarifies the amount of face time expected to spend with a patient—50 minutes.
Remaining unchanged is behavioral care management code 99484, which is the same as the current description for HCPCS G0507, and there are no big changes moving from HCPCS to CPT® for the collaborative care management codes.
For observation E/M, four codes get tweaked: There is a slight change to the verbiage of one discharge and three initial observation care E/M codes, 99217-99220. Webb said that the CPT® update adds the term “outpatient hospital” to describe the observation status.
Major Changes to Ob/Gyn Coding for 2018
Other major changes to be aware of include:
- New codes have been created as a result of bundling mandates from the AMA’s Relativity Assessment Workgroup.
- A new code now describes a combined bone marrow biopsy and aspiration study.
- Abdominal x-ray codes 74000, 74010 and 74020 are deleted and three new codes were added to report abdominal x-ray procedures; Webb said the hope is that the changes increase the flexibility and accuracy for coding customized exams.
- Chest x-ray codes 71010, 71015, 71020, 71021, 71022, 71023, 71030, 71034 and 71035 will be deleted; four new codes have been created to report chest x-ray procedures described by the number of views vs. view-specific descriptors.
Webb noted that it is the physician who is responsible for accurately, completely and legibly documenting all the services provided and performed, though the actual coding can be passed off to a coder or biller. Meanwhile, it’s the patient’s responsibility to review and understand his or her medical insurance benefit policy.
