Understanding the Most Important Updates in the 2017 CPT Manual

As with every other annual edition, the 2017 CPT Manual includes many changes to the prior Current Procedural Terminology code set changes. (The manual is the AMA's official coding resource for procedural coding rules and guidelines, designed to help readers perform accurate claims submissions.)

Which changes matter most for your organization depends on your practice’s scope and specialty, since providers across the landscape of healthcare are subject to big updates for the new calendar year. All told, there are a total of 117 new CPT codes, 34 revised CPT codes, and 82 deleted CPT codes in the updated code set.

Read on for a brief rundown of the most notable and interesting changes to know, and be sure to consult the guidebook itself for further details on the updates that will affect your practice in particular. To be sure all of your codes and claims are submitted accurately and on-time in alignment with the updated code set, consider contracting with a trusted medical billing service.

Flip through the newest annual manual and you may notice something missing. Remember the bullseye icon, which signified that the designated service included conscious (moderate) sedation? You won’t find it in this year’s edition.

From now on, the administration of moderate sedation must be separately coded in addition to the associated with the surgical code. Six new conscious sedation codes were added to report moderate sedation services in 15-minute increments: 99151-99153, for sedation provided by the physician also performing the service for which sedation is being provided; and 99155-99157 for sedation services provided by another physician or other qualified healthcare professional.

The change addresses an important issue. Medicare claims data had consistently demonstrated that anesthesia services were being reported for codes that already included moderate sedation as inherent to the work of physician in the procedure. To account for the shift, the relative value units (RVUs) associated with each code that had previously included moderate/conscious sedation have been adjusted to reflect the change.

With adoption of telemedicine gaining traction, the CMS has finally deployed the new modifier 95 for ‘synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.’

Epidurals are now coded based on the use of imaging, using codes 62320-62327. The descriptor for the codes with imaging specifies fluoroscopy or CT, but the 2017 CPT guidelines state the codes that include imaging may not be reported with fluoroscopy (77003), CT (77012) or ultrasound (76942).

CPT has adopted CMS’ model for presumptive drug screens, so providers now have only one set of rules to follow. Report one of three codes (80305-80307) based on the test method used to report it with one unit of service.

Influenza vaccine codes will now be coded by dosage, not age. For example, in code 90655, “when administered to children 6-35 months of age” has been removed. Instead, the code now refers to “0.25 mL dosage.” The change affects codes 90655-90661 and 90685-90688.

Of course, the changes above represent only a small portion of the updates in the 2017 manual. Read up on your specialty-specific sections of the guidebook for further information, and consult a medical billing firm if you’re struggling with your coding and claims processes.

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