Code Changes for 2020

Question:I am aware that diagnosis codes for 2020 updated Oct. 1, 2019, but what about CPT codes? And do you have any information about codes that may affect chiropractic providers?

You are indeed correct that ICD-10 coding makes its updates on Oct. 1 for the following year. This means the codes actually update on that date and any date of service on or after Oct. 1 must use the new or updated code to be valid. CPT codes or procedure codes actually do not update or become effective until Jan. 1. It is important to understand this distinction, the dates of enactment, and adjust your billing protocols accordingly each year as applicable.

For instance, in 2017 there were multiple new codes for cervical disc. To this date, I still get offices inquiring about denials for their cervical disc codes. Of course, they are using a code that was deleted. (Note: Cervical disc codes were revised such that disc levels are specifically identified and not one-code-fits-all.)

Last year, there was also an update to the myalgia code (M79.1). It was revised to include new codes M79.10 to M79.18 for differentiating varied regions of myalgia; but I still have offices contacting me about why their (outdated) code was not accepted.

ICD-10 Code Changes

This year is no different, as codes are again updating, but there are no significant changes to the "common codes" used by doctors of chiropractic. There were no updates or changes to commonly used neuromusculoskeletal codes. That said, there are codes that may be of merit for some DCs.

Vertigo has been updated to a simpler code. The code for vertigo now is H81.4 and indicates vertigo of central origin. The prior code set indicated separate codes for the right ear, left ear, bilateral ears or unspecified ear. So, interestingly the code became more generic and simplified in this case.

There also new codes for congenital foot deformities that now have specific codes related to left and right foot; previously, there was no such designation. This includes talipes equinovarus, talipes calcaneovarus, metatarsus primus varus, metatarsus adductus, varus deformities of feet, talipes calcaneovalgus, pes cavus, and deformity of feet, unspecified.

These codes are Q66.00 to Q66.92, and may be important for practices that utilize foot orthoses, as a foot diagnosis is a requirement for these claims.

Ehlers-Danlos syndrome has also been updated to include more specific identification of the disease. The new codes are Q79.60 to Q79.69 and encompass unspecified, classical, hypermobile, vascular and other Ehlers-Danlos syndrome.

CPT Code Changes

Moving to Current Procedural Coding, there are some updates to be aware of. First off, there is a deletion of codes for muscle testing 95831-95834 with no replacement, meaning that it will be inclusive to the office visit / exam.

There will also be new codes in the "surgery" section for so-called "dry needling." Although not applicable to all states / providers, your scope may include some added language or rules that allow or require additional hours. There are two new codes for "needle insertion(s) without injection(s)" in the "surgery" section of the CPT Manual: 205X1 1-2 muscles and 205X2 2-3 muscles.

The AMA also added new guidelines to code 9714 and the acupuncture codes 97810-97814 that you are to use with the new codes for "dry needling or trigger point acupuncture."

Note these new codes do not necessarily indicate reimbursement, as most carriers to date have indicated that dry needling is considered experimental and not payable. (Note that the code for laser S8948 has been around for over a decade and is not payable, indicating the same reasoning. Stay tuned.)

There are also updates to online evaluation codes, with new coding for such encounters. The new codes and their associated guidelines include exclusions as to when these codes can and cannot be used.

The most prominent is that if there is an Evaluation and Management (E/M) visit within seven days before or after an online evaluation, you cannot report these codes separately because the service is considered part of the E/M service. The prior guideline indicated within seven days prior or next available appointment, but now indicates seven days on both ends.

Reporting them separately would be considered "double-dipping," which could easily be done unintentionally. . The new codes are: 99421 online digital evaluation and management service, for an established patient, for up to seven days, cumulative time during the seven days, 5-10 minutes; 99422 11-20 minutes; and 99423 21 or more minutes.

These codes are for use when E/M services are performed in an online platform and the type that would be done face-to-face through a HIPAA-compliant secure platform. These are for patient-initiated communications and may be billed by clinicians who may independently bill an E/M service. They may not be used for work done by clinical staff or for clinicians who do not have E/M services in their scope of practice. Report these services once during a seven-day period for the cumulative time.

For non-physician health care providers, the respective new codes for an online visit are 98970, 98971 and 98972, and utilize the same parameters related to office visit and time.

The new codes are spurred by digital health tools that are growing in popularity, such as patient portals. These tools enable patients and physicians to connect asynchronously and outside of face-to-face settings, making it easier for patients with transportation and scheduling barriers to get questions answered and receive care.

Editor's Note: Submit billing questions to Mr. Collins at sam@hjrossnetwork.com. Your question may be the subject of a future column.