It’s that time of year again. The American Medical Association has implemented the 2020 Current Procedural Terminology (CPT) code set. This year we have 394 changes: 248 additions, 71 deletions, and 75 revisions. All changes took effect on January 1.

While the impact to urgent care is minor, several items bear highlighting

Health Behavior Assessment and Intervention

The codes in the Health Behavior Assessment and Intervention section are used to report services provided to improve a patient’s health and wellbeing utilizing psychological and/or psychosocial interventions. Services focus on the assessment and intervention on factors complicating medical conditions and treatments that are physical in nature.

For 2020, the AMA revamped this section by deleting codes 96150 to 96155 and establishing the new codes 96156-96171. The “+” indicates an add-on code.

 

CPT Description
96156 Health behavior assessment, or reassessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)
96158 Health behavior intervention, individual, face-to-face; initial 30 minutes
+96159 Health behavior intervention, individual, face-to-face; each additional 15 minutes (list separately in addition to code for primary service)
96164 Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes
+96165 Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 minutes (list separately in addition to code for primary service)
96167 Health behavior intervention, family (with the patient present), face-to-face; initial 30 minutes
+96168 Health behavior intervention, family (with the patient present), face-to-face; each additional 15 minutes (list separately in addition to code for primary service)
96170 Health behavior intervention, family (without the patient present), face-to-face; initial 30 minutes
+96171 Health behavior intervention, family (without the patient present), face-to-face; each additional 15 minutes (list separately in addition to code for primary service)

With the new set of codes comes a fresh set of guidelines to explain the difference between assessment and interventions. Assessments include evaluation of the patient’s responses to disease, illness or injury, outlook, coping strategies, motivation, and adherence to medical treatment conducted through health-focused clinical interviews, observation, and clinical decision making. Interventions include promotion of functional improvement, minimizing psychological and/or psychosocial barriers to recovery, and management of and improved coping with medical conditions with services provided individually, in a group of two or more patients, and/or to the family with or without the patient present.

At least 16 minutes of service are required to report codes 96158, 96164, 96167, and 96170. Evaluation and management services should not be reported by the same provider on the same date.

 

Crosswalk

2019 Code For 2020 See…
96150
96151
96152
96156
96158
+96159
96153 96164
+96165
96154 96167
+96168
96155 96170
+96171

 

Revised Codes

When looking at year-end coding changes, it is as important to review revised codes as it is to look at the new or deleted codes. While continued use of the codes may not result in denials, clinics should be aware of changes to the code description to make sure the documentation supports the services reported.

Following are two codes commonly reported in the urgent care setting that have been revised for 2020:

  • Meningococcal Vaccine – CPT 90734
     The description for code 90734 was revised to make it consistent with the new code 90619 and to distinguish the type of meningococcal vaccine and carrier it describes.

 

2019 Description 2020 Description
Meningococcal conjugate vaccine, serogroups A,C,Y and W-135; quadrivalent (MCV4 or MenACWY), for intramuscular use Meningococcal conjugate vaccine, serogroups A,C,W,Y quadrivalent, diphtheria toxoid carrier (MenACWY-D) or CRM197 carrier (MenACWY-CRM), for intramuscular use

Documentation should include the exact vaccine product administered.

The description for code 90619 is Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, tetanus toxoid carrier (MenACWY-TT), for intramuscular use.

  • Complete Acute Abdomen Series – CPT® 74022
    The description for code 74022 was revised to define the views included in a complete acute abdomen series. Previously the code did not specify the number of abdominal views included.

 

2019 Description 2020 Description
Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views; single view chest Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect, decubitus), and a single view chest

Documentation should include interpretation of two or more views of the abdomen and a single view of the chest.

 

Ringing in 2020 with CPT Changes

Monte Sandler

Executive Vice President, Revenue Cycle Management of Experity (formerly DocuTAP and Practice Velocity ).
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