The New Year is heading our way fast, and with it are coming a bundle of oncology CPT® coding updates. For example, you’re in store for new codes for interprofessional consultations, BRCA gene analysis, and breast MRIs—as well as a new coding structure for fine needle aspiration (FNA).
You’ll need to get the skinny on these changes fast—and you can by attending the latest oncology CPT® coding webinar offered by consultant Kim Garner-Huey. Having recently attended the CPT® Symposium (where the physicians who wrote the codes explained the changes), she’s sure to have the latest and most direct-from-the-source information to share with you.
To whet your appetite, here’s a brief preview of what you’ll discover…
2 New Codes for Interprofessional Consultations
It’s no secret that remote patient care and consulting between physicians not in the same geographical area are becoming more important and widely used due to advances in technology. That’s why the Centers for Medicare and Medicaid Services (CMS) jumped on the bandwagon to give you two new codes to describe these services. These codes are:
- 99451, Interprofessional telephone/internet/EHR 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 of medical consultative time
- 99452, interprofessional telephone/internet/EHR referral service(s) provided by a treating/requesting physician or other qualified healthcare professional, 30 minutes
When coding, pay attention to who provided the services (consulting or treating physician), as well as how much time the services took. And ask for clarification if the documentation isn’t clear.
5 BRCA Codes for Your Repertoire
Out of all the new oncology CPT® codes for 2019, 5 deal with BRCA gene analysis. They are:
BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis
- 81163, full sequence analysis
- 81164, full duplication/deletion analysis (i.e., detection of large gene rearrangements)
BRCA1 (BRCA1, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis
- 81165, full sequence analysis
- 81166, full duplication/deletion analysis
The last new BRCA code is 81167, whose definition is exactly like 8166 except it is for BRCA2.
New Breast MRI Codes: Unilateral or Bilateral?
You’ll also have 4 new breast MRI codes to put into use starting January 1, 2019 — the CPT® implementation deadline.
MRI, breast, without contrast material
- 77046, unilateral
- 77047, bilateral
MRI, breast, without and with contrast material(s), including computer-aided detection, when performed
- 77048, unilateral
- 77049, bilateral
New Coding Structure for FNA
Pay close attention: The way you code for FNA is about to be completely upended. The structure as of January 1, 2019, is seen below. For each type of guidance—ultrasound, fluoroscopic, computed tomography (CT), or magnetic resonance (MR)—you have one code to report the first lesion and another to report each additional lesion.
Including ultrasound guidance
- 10005, FNA biopsy, first lesion
- 10006, FNA biopsy, each additional lesion
Including fluoroscopic guidance
- 10007, FNA biopsy, first lesion
- 10008, FNA biopsy, each additional lesion
Including CT guidance
- 10009, FNA biopsy, first lesion
- 10010, FNA biopsy, each additional lesion
Including MR guidance
- 10011, FNA biopsy, first lesion
- 10012, FNA biopsy, each additional lesion
Note: For codes 10006, 10008, 10010, and 10012, list them separately in addition to the code for the primary procedure.
Note also that you can “mix and match” the codes to report medically-necessary services. So you could, for example, use 10011 to report a biopsy of an initial lesion using MR guidance plus an add-on code for FNA of an additional lesion without guidance, or with another type of imaging guidance. If this happens, however, be careful. Report the code for the FNA of the first lesion as usual, and append modifier 59 (distinct procedural services) to the add-on codes using another type of imaging guidance.
Keep the Reimbursement Flowing in 2019
When it comes to oncology CPT® coding in the New Year, you’ve got a lot of upgrading to do. Get the insider guidance and hand-holding you need from Huey’s webinar, “2019 CPT® Coding Update for Oncology.” She’ll explain added codes, revised definitions, and adjusted coding structures—and more.
