AMA Announces Major CPT Code Changes for 2018

The American Medical Association (AMA) released several changes to CPT codes and descriptors during its 2018 CPT and RBRVS symposium held in Chicago Nov. 15-17. Physicians and their medical coding service providers need to prepare themselves for a total of 312 edits in CPT and a total of 10,155 code sets for 2018, including 170 new CPT codes, 60 revised codes, and 82 deleted codes as well as two new modifiers.

  • Added, Revised and Deleted CPT Codes
    Here is a list of the 2018 CPT code changes as listed in a report from ICD-10 Monitor

    SectionsAddedRevisedDeleted
    E&M542
    Anesthesia505
    Surgery422419
    Radiology7318
    Path/Lab401712
    Medicine13104
    Category II000
    Category III41222
    PLA Codes1700
    Total1706082
  • New Modifiers
    There are 2 new modifiers to identify Habilitative Services and Rehabilitative Services

    • Modifier 96 – Habilitative Services: When a habilitative or rehabilitative service or procedure is provided for habilitative purposes, the physician or other qualified healthcare professional may add modifier 96- to the service or procedure code to indicate that the service or procedure provided was habilitative. Such services help an individual learn skills and functioning for daily living that the individual has not yet developed, and then keep or improve those learned skills.
    • Modifier 97- Rehabilitative Services: When a habilitative or rehabilitative service or procedure is provided for rehabilitative purposes, the physician or other qualified healthcare professional may add modifier 97- to the service or procedure code to indicate that the service or procedure provided was rehabilitative. Rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled.
  • CPT Code

  • Other Noteworthy CPT Changes

    • Evaluation and Management (E&M) Codes
      • 3 new codes for psychiatric collaborative care management services
      • 1 new code for general behavioral health integration care service
      • 4 observation care services revised
      • Deleted: 2 anticoagulation management service codes
      • 2 new codes for INR home and outpatient INR monitoring services
    • Anesthesia Codes
      • 2 new upper gastrointestinal endoscopic procedure anesthesia codes and deletion of 1 code
      • 3 new lower and upper/lower intestinal endoscopic procedure anesthesia codes and deletion of 1 code
      • 2 obturator neurectomy anesthesia codes deleted
      • Deleted: 1 code for anesthesia for shoulder spica case application
    • Surgery
      • Endovascular Surgery
        • The endovascular surgery section has 16 new codes, 5 revised codes and 13 deleted codes. The new codes pertain to endovascular repair of abdominal aorta and/or Iliac arteries with an emphasis upon repair using endografts, extension prosthesis, and concepts of delayed placement of prosthesis for endovascular repair of vessels.
        • Coding of these procedures is now determined and guided by “treatment zone” rather than the “targeted treatment zone.” The treatment zone includes all vessel(s) that are treated by the endograft.
        • Anything done to treat vessel(s) beyond the targeted treatment zone can be separately reported.
      • Integumentary System
        Code 17250 for chemical cauterization of granulation tissue (ie, proud flesh, sinus or fistula) is revised to remove reference to sinus or fistula and to direct that use of chemical cauterization to achieve wound hemostasis is not reported with code 17250. Cauterization to achieve hemostasis is included in the code for wound care, excision or repair.
        Code 17250 is not to be reported:

        • With removal or excision codes for the same lesion
        • When chemical cauterization is used to achieve wound hemostasis
        • In conjunction with active wound care management 97597, 97598, 97602 for the same lesion
    • Diagnostic Radiology
      • There are 4 new CPT codes (71045-71048) for chest X-rays:
        71045 Radiologic examination, chest; single view
        71046 2 views
        71047 3 views
        71048 4 or more views
      • There are 9 deletions associated with chest X-rays being categorized by the number of views (single through four or more reviews, as opposed to type of view.
      • 3 codes have been deleted in the abdominal X-ray section and three replacements introduced, 74018-74021, which are to be reported by the number of views taken versus type of view:
        74018 Radiologic examination, abdomen; 1 view
        74019 2 views
        74021 3 or more viewsCPT Code Changes
    • Plastic Surgery
      • Two new codes, 15730 and 15733, have been introduced for muscle flaps in order to facilitate the capture and reporting of flap grafts involving the midface and head and neck.
      • New codes 64912 and 64913 in the neurorrhaphy with nerve graft, vein graft, or conduit section will facilitate and allow reporting of nerve pedicle transfer with nerve allograft of each nerve and the add-on code, 64913, with nerve allograft, each additional strand.
    • Dermatology
      • 1 revised Category I code and 2 new Category I codes for photodynamic therapy
      • 2 new Category III codes for optical coherence tomography of skin
      • 2 new Category III codes for ablative treatment of burn scars
      • New CPT code 96573 to report photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa, with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified healthcare professional, per day. The service represented in CPT code 96573 is distinct from CPT code 96574, as the latter procedure includes debridement of the premalignant hyperkeratotic lesion(s) (i.e., targeted curettage, abrasion) followed with photodynamic therapy by external application of light.

    With the extensive changes in CPT codes for 2018, medical coding companies need to inform physicians of the importance of comprehensive clinical documentation and ensuring medical necessity for all services provided, charged, coded, and billed.