Internists provide care for a wide range of medical problems including chronic and serious conditions, and face many challenges when billing their services. There are several CPT code updates and guideline changes that will impact internal medicine in 2019. Reimbursement largely depends on correct and efficient medical coding, and partnering with an experienced internal medicine medical billing and coding company is the best way to stay updated and implement these changes.

In 2019, internal medicine practices have to deal with changes to the CPT codes for Evaluation and Management (E&M), lesion removal, biopsies and more.

  • 6 new E&M codes – E&M has 4 revised CPT codes and 2 new codes for interprofessional internet consultation:Revised
    • 99446 Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review
    • 99447 … 11-20 minutes of medical consultative discussion and review
    • 99448 … 21-30 minutes of medical consultative discussion and review
    • 99449 … but 31 minutes or more of medical consultative discussion and review

    New

    • 99451 Interprofessional telephone/Internet/electronic health record 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 or more minutes of medical consultative time
    • 99452 Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or qualified health care professional, 30 minutes
  • 3 New CPT codes for Chronic Care Remote Physiologic Monitoring – New and revised codes have been introduced, including a new subsection to describe digitally stored data services/remote physiologic monitoring:
    • 99453 Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment
    • 99454 Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
    • 99457 Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month

    The most important difference between CPT code 99457 and already existing CPT code 99091 (Remote Patient Monitoring) is that 99457 allows RPM services to be performed not only by the physician or qualified healthcare professional (QHCP), but also by clinical staff such as RNs and medical assistants. This is expected to make it easier for healthcare providers to incorporate RPM programs into their practice.

  • Skin Biopsy Code ChangesDeleted

    As of January 1, 2019, the following skin biopsy CPT codes will be deleted:

    • 11100 (for the first lesion)
    • 11101 (for each additional lesion biopsied after the first lesion on the same date of service)

    New

    The new code range for skin biopsy is CPT 11102-11107. These codes are based on method of removal which allows for greater specificity.

     

    • 11102 Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette) single lesion
    • + 11103 each separate/additional lesion (List separately in addition to code for primary procedure)
    • 11104 Punch biopsy of skin (including simple closure, when performed) single lesion
    • +11105 each separate/additional lesion (List separately in addition to code for primary procedure
    • 11106 incisional biopsy of skin (e.g., wedge) (including simple closure, when performed) single lesion
    • +11107 each separate/additional lesion (List separately in addition to code for primary procedure

    An ICD-10 Monitor article explains that when a skin lesion is entirely removed, either by excision or shave removal and sent to pathology for examination, it should be reported with the excision codes not biopsy CPT codes. Also, each biopsy performed on different lesions or different sites on the same day is performed separately and not considered a component of other procedures.

  • New instructional notes for Fine Needle Aspiration (FNA) codes – Starting January 1, 2019, fine needle aspiration cannot be reported separately with imaging guidance. A single code has been introduced to report fine needle aspiration of an initial lesion, without imaging guidance. Four new codes will come into effect to report fine needle aspiration of an initial lesion using specified imaging modalities, including ultrasound, fluoroscopy, computed tomography (CT), and magnetic resonance (MR).The upcoming CPT code changes for FNA are as follows:

    Deleted: 10022 Fine needle aspiration; with imaging guidance will be deleted.

    Revised: 10021 Fine needle aspiration; without imaging guidance with a new descriptor – Fine needle aspiration biopsy, without imaging guidance; first lesion

    New: In 2019, there are 9 new fine needle aspiration biopsy (FNAB) codes, which will include radiological supervision and interpretation. Each imaging modality will have 2 codes – a primary code for the first lesion and an add-on code for each additional lesion:

    • +10004 – … each additional lesion (List separately in addition to code for primary procedure)
    • 10005 – Fine needle aspiration biopsy, including ultrasound guidance; first lesion
    • +10006 – … each additional lesion (List separately in addition to code for primary procedure)
    • 10007 – Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion
    • +10008 – … each additional lesion (List separately in addition to code for primary procedure)
    • 10009 – Fine needle aspiration biopsy, including CT guidance; first lesion
    • +10010 – … each additional lesion (List separately in addition to code for primary procedure)
    • 10011 – Fine needle aspiration biopsy, including MR guidance; first lesion
    • +10012 – … each additional lesion (List separately in addition to code for primary procedure).

    Codes 10005-10012 have been added to report the specific imaging guidance (ultrasound, fluoroscopic guidance, CT and MRI).

  • Lymph Nodes and Lymphatic Channels New Code(s)
    New: 38531 – biopsy or excision of an open inguinofemoral lymph node

New CPT code 38531 is in the same range as other open lymph node biopsy or excision codes. 38531 has been added to the parenthetical for add-on code 38900 – Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure). Both 38531 and 38900 may be reported together when performed.

Codes for partial and complete radical vulvectomy (56630-56632 and 56633-56637) now have a new parenthetical instructing the user to report code 38531 when an inguinfemoral lymph node biopsy is performed without a complete inguinfemoral lymphadenectomy.

Besides helping physicians report the new CPT codes correctly, medical billing outsourcing companies provide comprehensive services to improve front-end processes such as charge creation, insurance eligibility verification and authorization, and AR.