2019 CPT® – New Codes and New Instructions

The American Medical Association (AMA) has released the 2019 CPT code set. It’s time to review the changes – to both the codes and the instructions on how to report them - that will become effective on January 1, 2019.

A review of CPT Appendix B – Summary of Additions, Deletions, and Revisions is a good place to start that process. You could look at this as a confirmation or continuation of the preparatory work you may have started this summer with the information that the Centers for Medicare & Medicaid Services (CMS) included in its proposed rule for the CY 2019 Medicare Physician Fee Schedule (MPFS). The proposed rule on the fee schedule now provides a peek at the new code set. For example, the code descriptor Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; age 5 years or older was referred to in the proposed rule as code 36X73. It is listed in 2019 CPT as code 36573. However, other important information about new/revised codes such as the value, the global period and other fee schedule indicators will not be available until CMS releases the Final Rule for the upcoming year’s fee schedule. Work to update the ASA CROSSWALK® and Relative Value Guide ® for 2019 is underway to provide you with all you need to be ready for coding/billing in 2019.

There are no changes to the Anesthesia codes for 2019. CPT’s Anesthesia Guidelines have been updated to include information on unlisted services/procedures. This update does not involve new information, but its addition makes the Anesthesia Guidelines more consistent with the guidelines for other sections of CPT relative to this matter.

ASA members who provide pain medicine care may see a few changes of note to them and their practices.

Code 64508 – Injection, anesthetic agent; carotid sinus (separate procedure) – has been deleted.
Significant changes to both the codes and the instructions associated with the analysis and programming of neurostimulators. Codes 95970, 95971 and 95972 have been revised, new codes have been added to this section and other codes within it are deleted for 2019. Instructions provide clarification on how all these codes are to be reported. For example:
- The codes for cranial nerve, spinal cord, peripheral nerve and sacral nerve neurostimulator analysis are reported based on the number of parameters adjusted during a session. Simple programing involves adjustment of one to three parameters and complex programing requires adjustment of more than three parameters. If a single parameter is adjusted multiple times during a session, that counts as one parameter.
- Analysis is considered inherent to implementation and not to be reported separately if done during the same session.

2019 CPT includes new instructions specific to imaging guidance. This is important since imaging is bundled into many of the pain procedures ASA members perform, eg interlaminar epidurals (codes 62321, 62323, 62325, 62327), paravertebral blocks (codes 64461 – 64463), transforaminal epidurals (codes 64479-64484),) TAP blocks (codes 64486-64489), paravertebral facet joint injections (codes 64490-64495) and facet joint ablation (codes 64633-64636). Imaging is also included in some of the codes that pertain to pumps and neurostimulators. (See glossary at end of this article for the full descriptors assigned to these codes.)

The new CPT instruction as it appears in the Surgery Guidelines states that,

“When imaging guidance or imaging supervision and interpretation is included in a surgical procedure, guidelines for image documentation and report, included in the guidelines for Radiology (Including Nuclear Medicine and Diagnostic Ultrasound), will apply.”

The pain procedures noted above are included in the surgery section of CPT so this instruction about documentation will apply to them. The referenced text from the Radiology Guidelines is as follows,

“Imaging may be required during the performance of certain procedures or certain imaging procedures may require surgical procedures to access the imaged area. Many services include image guidance, and imaging guidance is not separately reportable when it is included in the base service. The CPT code set typically defines in descriptors and/or guidelines when imaging guidance is included. When imaging is not included in a surgical procedure or procedure from the Medicine section, image guidance codes or codes labeled “radiological supervision and interpretation” (RS&I) may be reported for the portion of the service that requires imaging. All imaging guidance codes require: (1) image documentation in the patient record and (2) description of imaging guidance in the procedure report. All RS&I codes require: (1) image documentation in the patient’s permanent record and (2) a procedure report or separate imaging report that includes written documentation of interpretive findings of information contained in the images and radiologic supervision of the service.”

Glossary:

CPT® Code	2019 Descriptor
62321	Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or CT)
62323	Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)
62325	Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or CT)
62327	Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)
63661	Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed
63663	Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed
64461	Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed)
64462	Paravertebral block (PVB) (paraspinous block), thoracic; second and any additional injection site(s) (includes imaging guidance, when performed) (List separately in addition to code for primary procedure)
64463	Paravertebral block (PVB) (paraspinous block), thoracic; continuous infusion by catheter (includes imaging guidance, when performed)
64479	Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level
64480	Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional level (List separately in addition to code for primary procedure
64483	Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level
64484	Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level (List separately in addition to code for primary procedure)
64486	Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)
64487	Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by continuous infusion(s) (includes imaging guidance, when performed)
64488	Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance, when performed)
64489	Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by continuous infusions (includes imaging guidance, when performed)
64490	Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level
64491	Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary procedure)
64492	Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; third and any additional level(s) (List separately in addition to code for primary procedure)
64493	Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level
64494	Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure)
64495	Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)
64633	Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint
64634	Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure)
64635	Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint
64636	Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure)
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