CPT and HCPCS coding updates for 2019

Sept. 21, 2018 / By Camille Ruiz, RHIA

As the last day of summer fades, fall is on the horizon with Halloween displays and pumpkin spice lattes. For those of us in hospital middle revenue cycle—whether CDI, CDM or HIM—we are busy reading the Federal Register to prepare for the 2019 coding updates. Well, maybe not all 42,000+ pages in the latest issue, but just some of the highlights. For outpatient coding updates, I remind everyone to check both CPT and HCPCS additions. Some hospitals require clinical departments to submit their CPT/HCPCS updates to their CDM analysts, while other fortunate hospitals have a strong CDM Department or Revenue Integrity department to guide CPT/HCPCS updates. 

It has been my experience that clinical departments normally purchase CPT coding books and educational material but not HCPCS books. This might create an educational gap causing coders to unwittingly omit Medicare-specific HCPCS codes that may supersede the CPT code. Adding a CPT code to the CDM that is superseded by a Medicare-specific HCPCS causes several issues down the revenue cycle stream. It is industry standard for CDMs to follow Medicare guidelines.  Medicare claims with the CPT code will trigger a denial, although you must use the CPT code for commercial claims. Most patient accounting systems can handle “switching” the codes based on the payer type. It is important to note that the CPT and HCPCS code descriptions should be exact. It may require more than a “switch” in codes if the descriptions are not the same. For example, note the time difference in the Hyperbaric Oxygen (HBO) Therapy CPT and HCPCS code descriptions:

CPT        99183    HBO PER SESSION


Where does that leave someone without adequate coding resources? Besides making friends with a coder, you can perform the task (albeit slowly) by downloading the CMS file Addendum B – OPPS Payment by HCPCS Code. Each CPT and HCPCS is assigned a Status Indicator. Look for Status Indicator B-Codes that are not recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x and 13x). These codes assigned a Status B Indicator may have an alternate code that is recognized by CMS OPPS when submitted on an outpatient hospital Part B bill type (12x and 13x). Several alternative codes currently exist for imaging and pharmacy.  Checking for alternative codes and requesting the necessary patient accounting builds is time well spent compared to correcting denials and delaying revenue. Enjoy your fall. Keep coding!

Camille Ruiz is an outpatient CDI consultant at 3M Health Information Systems.