By Carol Hoppe, CPC, CCS-P, CPC-I
MedLucid Solutions

Next month: E/M documentation changes in the 2019 CMS Final Rule.

New CPT® codes and telehealth HCPCS codes from CMS became effective Jan. 1 and could be significant for physicians, depending on their specialties. Here’s a brief summary of just a few key changes that could affect your practice. This is not an all-inclusive list, so please refer to the 2019 CPT®, HCPCS, and ICD-10 codebooks for a full description of the codes to ensure appropriate coding and reimbursement in 2019.



Two new E/M telehealth codes (99451 and 99452) are now available for written interpersonal telehealth communication between consulting and treating/requesting providers. Three codes (99453, 99454, 99457) were added for remote physiologic monitoring services.

New Medicare telehealth codes 

Two HCPCS add-on codes are for “prolonged preventive service(s) in the office or other outpatient setting requiring direct patient contact beyond the usual service”; first 30 minutes (G0513) and each additional 30 minutes (G0514). These codes are billable with appropriate telehealth preventive services (available on the CMS website). 
Medicare also added code G2012 for a “virtual check” – five to 10 minutes of medical discussion with the billing provider, when an office visit is not deemed necessary. Code G0212 requires documentation of patient’s verbal consent as well as the total time spent discussing the patient’s condition.

Modifier G0 was added for telehealth services furnished for diagnosis, evaluation, or treatment of symptoms of acute stroke.
Integumentary system – 16 new biopsy codes
Codes 10022, 11100 and 11101 were deleted for fine needle aspiration (FNA) and skin biopsies. Code 10021 was revised to include “without imaging guidance,” while several new codes represent FNA biopsies with imaging: 



The other sections of CPT® had various changes, as new and advanced procedures made their way into CPT®. There are many new and revised codes in the medicine section and Category III codes, including one new flu vaccine code, electroretinography services, developmental, psychological testing and neuropsychological testing, just to name a few. Please refer to 2019 CPT® for a full description of all changes. 

For answers to questions about the new codes or to receive education for your practice on the changes, please contact the ISMA for assistance.

REFERENCES CPT© 2018 American Medical Association. All Rights Reserved. CPT® is a registered trademark of the American Medical Association. New Modifier for Expanding the Use of Telehealth for Individuals with Stroke MLN Matters Number: MM10883 Related CR Release Date: September 28, 2018 Related CR Transmittal Number: R2142OTN Related Change Request (CR) Number: 10883 Effective Date: January 1, 2019 Implementation Date: January 7, 2019