Pulmonology Coding Alert

You’ll also see a revision to airway resistance by oscillometry code 94728.

Some years, the new edition of CPT^® seems like it’s targeted straight at pulmonologists, while other years the AMA goes easier on the updates to chest physicians. This year appears to be more of the latter, with very few pulmonology-specific updates to CPT^®, but some important code changes to note.

Background: The 2020 CPT^® code set was recently released, with 394 total code changes that include a startling 248 new codes, as well as 75 revised descriptors and 71 deletions.

Read on for the updates most relevant to pulmonology providers.

Check These Chest Tumor Excision Changes

If you ever report chest tumor excision codes 19260-19272 (Excision of chest wall tumor…), you’ll need to strike those from your coding list in the new year, because they are on the deleted list for 2020. Instead, you’ll report the following three new codes that describe these services:

• 21601 (Excision of chest wall tumor including rib(s))
• 21602 (Excision of chest wall tumor involving ribs, with plastic reconstruction; without mediastinal lymphadenectomy)
• 21603 (… with mediastinal lymphadenectomy)

These changes appear to reflect a shift of these codes from the integumentary surgery section of the CPT^® manual to the musculoskeletal surgery section of the code set. Other than the relocation and renumbering, the code descriptors did not change.

In addition, CPT^® has revised 94728 (Airway resistance by impulse oscillometry) to remove the word “impulse” from the descriptor effective Jan. 1.

Take a Red Pen to 99444

If you perform digital or e-visit E/M services, note that they will be coded quite differently than in the past, with CPT^® now deleting 99444 (Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network).

In its place, CPT^® will introduce 99421 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes) on January 1.

Like its predecessor, 99421 has some significant restrictions, which stipulate that the service must be:

• Provided to an established patient (or guardian),
• Provided by a physician or other qualified health care professional (QHP), and
• Unrelated to an E/M service provided within the previous seven days.

This means that any online digital E/M service that results from a previous, or that results in a subsequent, E/M visit is not separately reported, and the online E/M service is incorporated into the related E/M visit.

In addition, CPT^® has placed a seven-day cumulative time limitation on 99421 and made the code time-dependent. You will be able to use 99421 if your provider spends between five and 10 minutes on any asynchronous communications with the patient in that time; you will also be able to report longer time increments with 99422 (… 11-20 minutes) or 99423 (… 21 or more minutes).

Time Changes Hit 98970 Series

You’ll also say goodbye to code 98969 (Online assessment and management service provided by a qualified nonphysician health care professional to an established patient or guardian, not originating from a related assessment and management service provided within the previous 7 days, using the Internet or similar electronic communications network), effective January 1.

In its place, you’ll be able to use three new time-based codes to report the same, asynchronous online services to your patients:

• 98970 (Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes)
• 98971 (… 11-20 minutes)
• 98972 (… 21 or more minutes).

“With the advance of new technologies for e-visits and health monitoring, many patients are realizing the best access point for physician care is once again their home,” said AMA President Patrice A. Harris, MD in a statement about the new changes. “The new CPT® codes will promote the integration of these home-based services that can be a significant part of a digital solution for expanding access to health care, preventing and managing chronic disease, and overcoming geographic and socioeconomic barriers to care.”