2018 Coding Updates

2018 Coding Updates

A new year brings new code changes. With 2018 just around the corner, there is little time to get ready for all the changes that will be taking place.

A number of new codes and guideline revisions will be implemented for 2018.  As in past years, many of the new codes have been created as a result of bundling mandates from the AMA’s Relativity Assessment Workgroup (RAW) for the purpose of identifying potentially misvalued services.

Diagnostic Radiology

Chest X-ray Codes 

Chest x-ray codes 71010, 71015, 71020, 71021, 71022, 71023, 71030, 71034, and 71035 will be deleted and four new codes created to report chest x-ray procedures described by the number of views vs view-specific descriptors. 

Chest x-ray codes were identified in the 2016 Medicare Physician Fee Schedule (MPFS) Notice of Proposed Rule Making, Potentially Misvalued Codes Identified through High Expenditure by Specialty Screen.  After the Relative Value Scale Update Committee’s (RUC) mandate to revise these codes, the ACR requested an update in the descriptor language in order to increase the flexibility and accuracy for coding customized exams, which currently are coded with view-specific descriptors.

2018 Orthopedics Coding Updates

With the new year just around the corner, there’s little time to get ready for all the changes that are taking place in the 2018 CPT Coding. New appearances of physical therapy and grafting codes will affect coding in the orthopedic office, and nerve repair codes are changing as well.

·       New trends in CPT codes for orthopedics in 2018

·       Review of new orthopedics CPT codes

·       4 code additions in CPT codes for orthopedics in 2018

·       9 code revisions in CPT codes for orthopedics in 2018

·       7 code deletions in CPT codes for orthopedics in 2018

·       Updated NCCI guidelines for 2018

·       Documentation and modifier use issues and other issues resulting in denials

Medicine

Vaccines

Although effective July 1, the following changes will appear in the 2018 CPT manual to indicate the vaccine schedule changes.

#▲90621 Meningococcal recombinant lipoprotein vaccine, serogroup B (MenB-FHbp), 2 or3 dose schedule, for intramuscular use

#▲90651 Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 2 or 3 dose schedule, for intramuscular use

The following influenza vaccine codes were added to the 2018 CPT manual; CPT code 90756 took effect in January 2017.

● 90682 Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use

# ● 90756 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use

Evaluation and management

Observation care services

The term “outpatient hospital” was added to all observation care services descriptors to clarify that these codes are to be reported when a patient is admitted to outpatient hospital observation status.

Special Note:  The revised guidance would focus on medical decision-making and time as the key indicators for a give level of service. This resembles the last comments made by CMS about finalizing E&M guidelines back in 1999, when they were to have come up with a 'weighted' system that valued decision-making more than the other E&M components.

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