CPT code changes in 2020: What hospital revenue cycle staff should know before Jan. 1

There are 394 total Current Procedural Terminology code changes coming in 2020, including 248 new codes, 71 deletions and 75 revisions. Is your revenue cycle staff prepared? Becker's Hospital Review recently caught up with Mark Synovec, MD, chair of the American Medical Association's CPT editorial panel, to gain more insights into the code changes, which take effect Jan. 1.

Editor's note: Responses were lightly edited for length and clarity.

Question: Among important additions for 2020 are new codes to report online digital evaluation services, or e-visits, as well as new codes self-measured blood pressure monitoring, according to the AMA. What prompted these specific changes? 

Mark Synovec: The CPT editorial panel looks at a set of established criteria that is publicly available to determine whether a code change application [from healthcare stakeholders including medical specialty societies, allied health organizations, the federal government and payers,] should be approved. At a high level, the panel approves a code change application when it meets all the requirements of established criteria.

Regarding the new codes for e-visits, the panel agreed that the expanded use of EHRs and associated, HIPAA-complaint secure patient portals has renewed focus on the important role played by non-visual digital patient-physician communication. Given the robust literature submitted to confirm their wide-spread use and clinical usefulness, the e-visit codes were approved for the CPT 2020 code set.

In 2008 CPT codes 99444 and 98969 were created to describe online evaluation and management services performed by both a physician and non-physician qualified healthcare professional, respectively. These codes were not widely adopted by payers due to a lack of clear definitions surrounding the work involved in these online visits. Furthermore, the current online evaluation and management codes did not fully characterize the evolution that has occurred with these services.

There have never been self-measured blood pressure monitoring codes in the CPT code set. There are currently four ambulatory blood pressure monitoring codes [93784, 93786, 93788 and 93790], but they only describe continuous monitoring over at least 24 hours. 

The panel found it compelling that these new self-measured blood pressure monitoring codes were congruous with the recently updated United States Preventive Services Task Force recommendations for screening of high blood pressure. The task force found that SMBP using appropriate protocols, as outlined in the CPT codes, is a valid alternative method of confirmation when other methods are not available.

Furthermore, the SMBP new codes will expand the ability for a diversity of patient populations to receive reliable blood pressure readings. Patients in rural areas may not be able to live close enough to an ambulatory setting to receive regular, continuous monitoring or may lack access to purely digital forms of monitoring. These new codes expand access to these vulnerable populations.

Q: What are the main goals behind the code changes? 

MS: The new e-visit codes expand the definitions around the work that is being performed and how to report these e-visits along with other services.

The new SMBP codes are more closely aligned with clinical guidelines that have shown the advantage of collecting blood pressure outside of the clinic setting for diagnosis of hypertension, which can result in measurement errors, a smaller number of measurements and white coat hypertension.

Q: What else should hospital revenue cycle staff know about the changes? 

MS: Medicare recently released their proposed rule for 2020 and proposed covering codes 99421, 99422, 99423 by assigning RVUs [relative value units]. Many of the private payers will follow the lead of Medicare. For the non-physician healthcare professional codes [98970, 98971, 98972] the work involved in these services are proposed to be covered through establishment of HCPCS G-codes. This was ultimately a coverage decision made by Medicare and the panel will be working to revise these CPT codes to try and meet the requirements of Medicare in 2020. 

All requests for CPT codes go through a rigorous review process. These codes were approved as category I codes which means that they had to meet high standards to establish clinical usefulness supported by peer-reviewed literature. While the CPT code set is a nomenclature and not involved in coverage and payment, the vast majority of established category I codes are covered by Medicare, Medicaid and commercial payers.

To learn more about the CPT code changes, visit the AMA website.


More articles on healthcare finance: 

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CMS blasted for nearly 2-year delay in payout of Medicare performance bonuses

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