Get out your 2019 CPT® code books. You have some code changes to make.
Effective July 1, 2019, the American Medical Association (AMA) is adding 21 new lab codes and deleting one in Appendix O, Multianalyte Assays with Algorithmic Analyses and Proprietary Laboratory Analyses.
| Deleted | |
| 0057U | Oncology (solid organ neoplasia), mRNA, gene expression profiling by massively parallel sequencing for analysis of 51 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a normalized percentile rank |
| New | |
| 0084U | Red blood cell antigen typing, DNA, genotyping of 10 blood groups with phenotype prediction of 37 red blood cell antigens |
| 0085U | Cytolethal distending toxin B (CdtB) and vinculin IgG antibodies by immunoassay (ie, ELISA) |
| 0086U | Infectious disease (bacterial and fungal), organism identification, blood culture, using rRNA FISH, 6 or more organism targets, reported as positive or negative with phenotypic minimum inhibitory concentration (MIC)-based antimicrobial susceptibility |
| 0087U | Cardiology (heart transplant), mRNA gene expression profiling by microarray of 1283 genes, transplant biopsy tissue, allograft rejection and injury algorithm reported as a probability score |
| 0088U | Transplantation medicine (kidney allograft rejection), microarray gene expression profiling of 1494 genes, utilizing transplant biopsy tissue, algorithm reported as a probability score for rejection |
| 0089U | Oncology (melanoma), gene expression profiling by RTqPCR, PRAME and LINC00518, superficial collection using adhesive patch(es) |
| 0090U | Oncology (cutaneous melanoma), mRNA gene expression profiling by RT-PCR of 23 genes (14 content and 9 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a categorical result (ie, benign, indeterminate, malignant) |
| 0091U | Oncology (colorectal) screening, cell enumeration of circulating tumor cells, utilizing whole blood, algorithm, for the presence of adenoma or cancer, reported as a positive or negative result |
| 0092U | Oncology (lung), three protein biomarkers, immunoassay using magnetic nanosensor technology, plasma, algorithm reported as risk score for likelihood of malignancy |
| 0093U | Prescription drug monitoring, evaluation of 65 common drugs by LC-MS/MS, urine, each drug reported detected or not detected |
| 0094U | Genome (eg, unexplained constitutional or heritable disorder or syndrome), rapid sequence analysis |
| 0095U | Inflammation (eosinophilic esophagitis), ELISA analysis of eotaxin-3 (CCL26 [C-C motif chemokine ligand 26]) and major basic protein (PRG2 [proteoglycan 2, pro eosinophil major basic protein]), specimen obtained by swallowed nylon string, algorithm reported as predictive probability index for active eosinophilic esophagitis |
| 0096U | Human papillomavirus (HPV), high-risk types (ie, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68), male urine |
| 0097U | Gastrointestinal pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 22 targets (Campylobacter [C. jejuni/C. coli/C. upsaliensis], Clostridium difficile [C. difficile] toxin A/B, Plesiomonas shigelloides, Salmonella, Vibrio [V. parahaemolyticus/V. vulnificus/V. cholerae], including specific identification of Vibrio cholerae, Yersinia enterocolitica, Enteroaggregative Escherichia coli [EAEC], Enteropathogenic Escherichia coli [EPEC], Enterotoxigenic Escherichia coli [ETEC] lt/st, Shiga-like toxin-producing Escherichia coli [STEC] stx1/stx2 [including specific identification of the E. coli O157 serogroup within STEC], Shigella/Enteroinvasive Escherichia coli [EIEC], Cryptosporidium, Cyclospora cayetanensis, Entamoeba histolytica, Giardia lamblia [also known as G. intestinalis and G. duodenalis], adenovirus F 40/41, astrovirus, norovirus GI/GII, rotavirus A, sapovirus [Genogroups I, II, IV, and V]) |
| 0098U | Respiratory pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 14 targets (adenovirus, coronavirus, human metapneumovirus, influenza A, influenza A subtype H1, influenza A subtype H3, influenza A subtype H1-2009, influenza B, parainfluenza virus, human rhinovirus/enterovirus, respiratory syncytial virus, Bordetella pertussis, Chlamydophila pneumoniae, Mycoplasma pneumoniae) |
| 0099U | Respiratory pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 20 targets (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus, coronavirus OC43, human metapneumovirus, influenza A, influenza A subtype, influenza A subtype H3, influenza A subtype H1-2009, influenza, parainfluenza virus, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, human rhinovirus/enterovirus, respiratory syncytial virus, Bordetella pertussis, Chlamydophila pneumonia, Mycoplasma pneumoniae) |
| 0100U | Respiratory pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 20 targets (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae) |
| 0101U | Hereditary colon cancer disorders (eg, Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis), genomic sequence analysis panel utilizing a combination of NGS, Sanger, MLPA, and array CGH, with MRNA analytics to resolve variants of unknown significance when indicated (15 genes [sequencing and deletion/duplication], EPCAM and GREM1 [deletion/duplication only]) |
| 0102U | Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer), genomic sequence analysis panel utilizing a combination of NGS, Sanger, MLPA, and array CGH, with MRNA analytics to resolve variants of unknown significance when indicated (17 genes [sequencing and deletion/duplication]) |
| 0103U | Hereditary ovarian cancer (eg, hereditary ovarian cancer, hereditary endometrial cancer), genomic sequence analysis panel utilizing a combination of NGS, Sanger, MLPA, and array CGH, with MRNA analytics to resolve variants of unknown significance when indicated (24 genes [sequencing and deletion/duplication], EPCAM [deletion/duplication only]) |
| 0104U | Hereditary pan cancer (eg, hereditary breast and ovarian cancer, hereditary endometrial cancer, hereditary colorectal cancer), genomic sequence analysis panel utilizing a combination of NGS, Sanger, MLPA, and array CGH, with MRNA analytics to resolve variants of unknown significance when indicated (32 genes [sequencing and deletion/duplication], EPCAM and GREM1 [deletion/duplication only]) |
New and Revised Category III Codes
The following Category III codes were accepted at the September 2018 CPT Editorial Panel meeting for the 2020 CPT® production cycle. These 20 new codes and one code revision also go into effect on July 1, 2019:
| Revised | |
| 0402T | Collagen cross-linking of cornea, (including removal of the corneal epithelium and intraoperative pachymetry, when performed) (Report medication separately) |
| New | |
| 0543T | Transapical mitral valve repair, including transthoracic echocardiography, when performed, with placement of artificial chordae tendineae |
| 0544T | Transcatheter mitral valve annulus reconstruction, with implantation of adjustable annulus reconstruction device, percutaneous approach including transseptal puncture |
| 0545T | Transcatheter tricuspid valve annulus reconstruction with implantation of adjustable annulus reconstruction device, percutaneous approach |
| 0546T | Radiofrequency spectroscopy, real time, intraoperative margin assessment, at the time of partial mastectomy, with report |
| 0547T | Bone-material quality testing by microindentation(s) of the tibia(s), with results reported as a score |
| 0548T | Transperineal periurethral balloon continence device; bilateral placement, including cystoscopy and fluoroscopy |
| 0549T | unilateral placement, including cystoscopy and fluoroscopy |
| 0550T | removal, each balloon |
| 0551T | adjustment of balloon(s) fluid volume |
| 0552T | Low-level laser therapy, dynamic photonic and dynamic thermokinetic energies, provided by a physician or other qualified health care professional |
| 0553T | Percutaneous transcatheter placement of iliac arteriovenous anastomosis implant, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention |
| 0554T | Bone strength and fracture risk using finite element analysis of functional data, and bone-mineral density, utilizing data from a computed tomography scan; retrieval and transmission of the scan data, assessment of bone strength and fracture risk and bone mineral density, interpretation and report |
| 0555T | retrieval and transmission of the scan data |
| 0556T | assessment of bone strength and fracture risk and bone mineral density |
| 0557T | interpretation and report |
| 0558T | Computed tomography scan taken for the purpose of biomechanical computed tomography analysis |
| 0559T | Anatomic model 3D-printed from image data set(s); first individually prepared and processed component of an anatomic structure |
| 0560T | each additional individually prepared and processed component of an anatomic structure (List separately in addition to code for primary procedure) |
| 0561T | Anatomic guide 3D-printed and designed from image data set(s); first anatomic guide |
| 0562T | each additional anatomic guide (List separately in addition to code for primary procedure) |
See the CPT® Category III Codes document for the parentheticals that go with these codes.
Errata and Technical Corrections
The AMA also released on March 6, an Errata and Technical Corrections – CPT® 2019 document to revise errors (E) and technical corrections (T). The following revisions are effective Jan. 1, 2019:
- Revision of codes in the parenthetical notes following codes 20933-20934. (E)
- This is in the Surgery / Musculoskeletal System, page 122. Several codes are added to the “do not report” with 20933 list and several codes are removed for the “do not report” with 20934 list.
- Revision of parenthetical note following codes 32601, 32604. (E)
- This is in the Surgery / Respiratory System, page 201. There’s a typo in the parenthetical note following codes 32601, 32604 – change “bipsy” to “biopsy.” (We all make mistakes!)
- Revision of parenthetical notes following codes 34714, 34716, 34833. (T)
- This is in the Surgery / Cardiovascular System section, pages 247-248. A change to the code range 33404-33417 was necessary to account for resequenced code 33440.
- Revision of guidelines for PICC line procedures. (T)
- This is also in the Surgery / Cardiovascular System section, page 267. The peripherally inserted central venous catheters (PICCs) coding guidelines are revised to replace the term “repositioning” with “complete replacement; and to remove code 36405 from the midline catheter guidelines.
- Addition of parenthetical note following code 90847. (T)
- This is in the Medicine / Psychiatry section, page 642. A new parenthetical note under 90847 instructs us to “see prolonged service codes for family psychotherapy services of 80 minutes or more.”
- Revision of Health and Behavior Assessment/Intervention guidelines. (T)
- This is in the Medicine section, page 716. Change the first line of the Health and Behavior Assessment/Intervention guidelines to read, “Health and behavior assessment procedures services are used to ….”
- Revision of name of Appendix O. (T)
- This is in Appendix O, page 858. Revise the subhead to “Multianalyte Assays with Algorithmic Analyses and Proprietary Laboratory Analyses.”
- Revision of codes in the Index under the “Repair” heading for “Malunion or Nonunion,” “Radius” and “Ulna.” (E)
- This is in the Index, page 1050. Under Repair/Radius/Malunion or Nonunion and Repair/Ulna/Malunion or Nonunion, change 25415 to 25405.
- Revision of a code in the Index under the “Ulna” heading for “Malunion or Nonunion, Repair” in the Index. (E)
- This in the Index, page 1080. Under Ulna/Repair/Malunion or Nonunion, change 25415 to 25405.
Remember: The existence of a code does not guarantee health plan coverage. Look to payers to release coverage updates for these new codes before using them.