The Current Procedural Terminology (CPT) manual underwent significant revisions in 2018, introducing 314 code changes that included new, revised, and deleted codes. While the majority of these changes impacted surgical procedures, several updates are crucial for urgent care centers to understand for accurate coding and billing. This article outlines the key CPT code changes for 2018 that are most relevant to urgent care settings.
Radiology Code Updates
Significant changes were implemented in radiology coding, particularly for chest and abdomen X-rays. The previous coding system based on anatomical regions was replaced with a view-based system. Here’s a breakdown of the new codes and their replacements:
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Chest X-rays:
- 71045: Radiologic examination, chest; single view (replaces 71010, 71015)
- 71046: Radiologic examination, chest; two views (replaces 71020, 71023, 71035)
- 71047: Radiologic examination, chest; three views (replaces 71021, 71022, 71035)
- 71048: Radiologic examination, chest; four or more views (replaces 71022, 71030, 71034)
- Fluoroscopy: For procedures previously coded under 71023, coders are now instructed to use 76000 (Fluoroscopy, up to one hour) or 76001 (Fluoroscopy, over one hour, assisting non-radiologist).
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Abdomen X-rays:
- 74018: Radiologic examination, abdomen; one view (replaces 74000)
- 74019: Radiologic examination, abdomen; two views (replaces 74010)
- 74021: Radiologic examination, abdomen; three or more views (replaces 74020)
These changes emphasize the importance of accurately documenting the number of views taken during radiographic examinations to ensure correct Cpt Coding 2018 Urgent Care billing.
New Flu Vaccine Codes
Two new influenza vaccines introduced in July 2017 were included in the 2018 CPT manual, impacting vaccine administration coding in urgent care settings:
- 90756: Influenza virus vaccine, quadrivalent (ccIIV4), cell culture derived, subunit, antibiotic-free, 0.5 mL dosage, for intramuscular use.
- 90682: Influenza virus vaccine, quadrivalent (RIV4), recombinant DNA derived, hemagglutinin (HA) protein only, preservative and antibiotic-free, for intramuscular use.
Urgent care providers must utilize these specific codes when administering these newer flu vaccines to ensure proper cpt coding 2018 urgent care compliance.
Cast and Strapping Application Updates
Codes for multilayer compression bandage applications, specifically 29582 (thigh and leg) and 29583 (upper arm and forearm), were deleted in the 2018 CPT updates. While no replacement codes were specified, urgent care centers should still accurately code for the supplies used in these procedures. This deletion requires careful attention to documentation and potentially necessitates using unlisted codes or alternative coding strategies depending on payer guidelines.
Pathology and Laboratory Code Additions
Within pathology and laboratory services, while genetic testing codes saw the most significant changes overall, urgent care centers should note the addition of two new Zika virus testing codes:
- 86794: Zika virus, IgM
- 87662: Zika virus, amplified probe technique
These codes became necessary for accurate billing of Zika virus diagnostic tests performed in urgent care or ordered through their labs.
Home and Outpatient INR Monitoring Services
Codes for anticoagulant management services, 99363 and 99364, were deleted and replaced with new codes focused on home INR monitoring:
- 93792: Patient/caregiver training for initiation of home INR monitoring, face-to-face, including monitor use, blood sample obtaining, result reporting instructions, and documentation of patient/caregiver competency.
- 93793: Anticoagulant management for warfarin patients, including INR test result review, patient instructions, dosage adjustment (if needed), and scheduling of additional tests.
Code 93793 guidelines specify it can’t be reported more than once daily and cannot be billed with Evaluation and Management (E/M) codes 99201-99215 or consultation codes 99241-99245. This restructuring of cpt coding 2018 urgent care for INR monitoring necessitates careful attention to these new codes and billing restrictions.
Cognitive Assessment and Care Plan Services
HCPCS Level II code G0505 was replaced by CPT code 99483 for cognitive assessment and care planning. Code 99483, “Assessment of and care planning for a patient with cognitive impairment,” is a comprehensive code requiring several elements:
- Cognition-focused evaluation with history and exam.
- Medical decision-making of moderate or high complexity.
- Functional assessment (ADLs, IADLs).
- Standardized dementia staging instruments (e.g., FAST, CDR).
- Medication reconciliation and high-risk medication review.
- Neuropsychiatric and behavioral symptom evaluation using standardized screening.
- Safety evaluation (e.g., home, driving).
- Caregiver identification, knowledge, needs, support, and willingness.
- Advance Care Plan development/review.
- Written care plan creation with referrals to community resources.
This service typically involves 50 minutes of face-to-face time with the patient and/or family. Urgent care centers offering cognitive assessments should utilize 99483 and ensure all required elements are documented for proper billing.
Pulmonary Diagnostic Testing and Therapies
Code 94618, “Pulmonary stress testing (e.g., six-minute walk test),” which includes heart rate, oximetry, and oxygen titration measurement, replaced deleted code 94620. Additionally, 94617 was introduced for “Exercise test for bronchospasm,” including pre- and post-spirometry, ECG recording(s), and pulse oximetry. These updates in cpt coding 2018 urgent care for pulmonary services require attention for accurate billing of these diagnostic tests.
Understanding these cpt coding 2018 urgent care changes is essential for urgent care centers to maintain accurate billing practices and ensure proper reimbursement. Staying updated with annual CPT manual revisions is a crucial aspect of compliant and effective urgent care operations.
