There are new, revised, and deleted codes for 2019. The most influential code sets that could affect your practice are the PICC line placements (36568-36573) and the new FNA biopsy codes (10004-10021). The wRVUs may be lower, but that should not influence your documentation of guidance used with these procedures.
2019 CPT Changes
FINE NEEDLE ASPIRATION BIOPSY
There has been a major update to the fine needle aspiration codes. Imaging is now bundled into the base procedure code.
Deleted:
Revised:
New:
How does this affect you?
CPT | Description |
2018 wRVUs |
2018 CMS Allowed |
CPT | Description |
2019 wRVUs |
2019 CMS Allowed |
|
10022 | FNA |
1.26 |
$73.94 |
10005 | FNA w/ US Guidance |
1.46 |
$75.68 |
|
76942 | US Guidance |
0.67 |
$36.18 |
|
||||
Total |
1.94 |
$110.12 |
|
*Please continue to state the guidance used in order to code the proper procedure code. If additional lesions are biopsied, please indicate that as well.
New requirement from the 2019 NCCI Manual:
“Fine needle aspiration (FNA) biopsies (CPT codes 10004-10012, and 10021) shall not be reported with a biopsy procedure code for the same lesion. For example, an FNA specimen is usually examined for adequacy when the specimen is aspirated. If the specimen is adequate for diagnosis, it is not necessary to obtain an additional biopsy specimen. However, if the specimen is not adequate and another type of biopsy (ie. needle, open) is subsequently performed at the same patient encounter, the physician shall report only one code, either the biopsy code or the FNA code. (CPT code 10022 was deleted January 1, 2019.)”
BREAST MRI
Deleted:
New:
*Please continue to state in your documentation whether the study was performed without or with/without contrast. Also, include if computer aided detection (CAD) was utilized.
KNEE ATHROGRAPHY
Deleted:
New:
Rationale according to CPT Changes An Insider’s View:
The AMA RUC RAW screen identified code 27370 for high-volume growth, and a recommendation was made to revise this code to reflect current practice. It was determined that if such extensive revisions were needed, a new code should be created and to delete 27370. The previous code did not include contrast enhanced CT/MRI knee arthrography. However, code 27369 can be reported for a knee injection for contrast arthrography or contrast enhanced CT/MRI knee arthrography.
PICC INSERTION AND REPLACEMENT
Revised:
New:
How does this affect you?
CPT | Description |
2018 Total RVUs |
2018 CMS Allowed |
CPT | Description |
2019 Total RVUs |
2019 CMS Allowed |
|
36569 | PICC Insertion |
1.70 |
$88.56 |
36573 | PICC Insertion w/ Guidance |
1.70 |
$96.46 |
|
76937 | US Guidance |
0.30 |
$14.76 |
36569 | PICC Insertion w/o Guidance |
1.90 |
$107.09 |
|
77001 | Fluoro Guidance |
0.38 |
$19.08 |
|
|
|||
Total |
2.38 |
$122.40 |
|
|
Per CPT:
*”Midline” catheters by definition terminate in the peripheral venous system. They are not central venous access devices and may not be reported as a PICC service. Midline catheter placement may be reported with 36400, 36405, 36406, or 36410.
Reminder*
Ultrasound guidance requires:
Fluoroscopic guidance requires:
G-TUBE REPLACEMENT
Deleted:
New:
If you have any further questions, please contact
Kristen Bickel Sliwinski CCA, RCC at kbickel@streamlinemd.com