New CPT Codes - Category III codes, Evaluation & Management

This is Part 5 of a five part series on the new 2022 CPT codes.  For the remaining areas we will just briefly summarize the section.  Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.

 

Modifiers

Two new modifiers were created for professional fee billing only. The second one is still under

consideration and not utilized at this time.

  • 63 – Procedure Performed on Infants less than 4 kg.

These procedures may involve significantly increased complexity. The modifier may only be appended to

codes in the 20100-69990 and list of 9XXXX codes in the appendix A listing.

Physician and QHC professional fee billing only. Not for hospital HOPPS reporting.

 

  • Y Modifier: Synchronous Telemedicine Service Rendered Via Telephone or Other Real-

  Time  Interactive  Audio-Only Telecommunications System: Synchronous telemedicine service is

  defined as a real-time  interaction between a physician or other qualified health care professional (QHP)

and a patient who is located away at a distant site from the physician or other QHP. The totality of the

communication of  information exchanged between the physician or other QHP and the patient during the

course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet

the key  components and/or requirements of the same service when rendered via a face-to-face interaction.

*(Under further panel consideration for timeline)

 

 

Category III Codes

Category III CPT codes are released semi-annually,  in January and July.  There are 74 new, 26 deleted and 7 revised Category III codes.  Review pages 873-916 of CPT book which indicate the new codes delineated by a red circle.   Many of the Category III codes not already discussed in the previous 4 parts of this series involve more diagnostic and testing procedures across all specialties.  Of note are the following new category III codes that may be of interest to coders:

  • 0640T-0642T Non-contact near-infrared spectroscopy of flap or wound
  • 0662T, + 0663T  Scalp cooling codes
  • 0673T Ablation, benign thyroid nodule(s), percutaneous, laser, including imaging guidance
  • 0686T Histotripsy, non-thermal ablation of malignant hepatocellular tissue
  • 0689-0690T Quantitative ultrasound of tissue characterization
  • 0691T Automated analysis of existing CT for vertebral fractures
  • 0692T Therapeutic ultrafiltration
  • 0693T-0706T Various imaging procedures or remote monitoring codes
  • 0707T Injection bone substance, into subchondral bone defect
  • 0708-0709T Intradermal cancer immunotherapy

 

There are more Category III codes that have not been reviewed in this series. Please review to make sure your facility does not report these other Category III codes. They are also hard to find in an encoder so please remember to look at this section in the actual CPT tabular.

 

Radiology

For radiology there are 4 new codes, 3 deleted, and 1 revised.  There two new codes 77089-77092 added for trabecular bone score (TBS) and various components of assessing this score

 

Medicine

For this section there are 36 new codes, 11 deleted, and 4 revised Medicine CPT Codes. A summary:

  • New COVID-19 vaccines 0001A-0042A, 91300-91304
  • New pneumococcal conjugate vaccines 13, 15, 20 valent, Hep B3
  • Already reviewed cardiology code changes earlier.
  • Outpt Pulm Rehab Services new codes 94625, 94626
  • Remote therapeutic monitoring and treatment codes 98975-98977, 98980-98981 and new guidelines

 

Laboratory and Pathology

There are 94 new codes, 8 deleted and 46 revised codes. Most of the new codes and revisions involve new drug assays and oncology lab tests.  Since many of these codes are inputted in the pathology or laboratory departments via chargemaster, the hospital will want to be sure the chargemaster is up to date and personnel in these departments are aware of the updates.

 

Appendices

Two appendices have been created to help the coder:

  • Appendix Q – Severe Acute Respiratory Syndrome Coronavirus 2 (SAERS-CoV-2) (coronavirus disease [COVID-19] Vaccines
  • Convenient to assess which vaccine codes and administration codes to use including names and dosing intervals
  • Appendix R – Digital Medicine-Services Taxonomy
  • A listing of digital medicine services described in the CPT code set.
  • Definitions are given for synchronous/asynchronous, data transfer, patient directed vs image/specimen directed, etc.
  • The taxonomy is intended to support increased awareness and understanding of approaches to patient care through the multifaceted digital medicine services available.

 

Evaluation and Management

Office and Other Outpatient E/M for FY2022:

  • Code 99211 was updated to remove the sentence: “Usually, the presenting problem(s) are minimal.”   That is because MDM does not apply to 99211.

 

Principal Care Chronic Care and Complex Chronic Care Management Services guidelines:

Here is a summary of the changes. Coders are encouraged to review the CPT book changes in depth:

  • Conversion of Medicare G codes for PCM to CPT codes
  • Add-on codes for principal care management (PCM) services
  • Add-on code for chronic care management by the physician or other qualified health care professional (QHP)
  • Alignment of CMS criteria (care plan, management and practice characteristics)
  • Clarifications related to other services (same month, same time, same communication and transitional care management (TCM)
  • Unit limits on reporting

      

                Four new codes (2 of which are add on codes) were added, 99424-99427 for principal care mgmt for

single high-risk disease that had been G-codes G0264 and G0265.  The add on codes are for 30 additional

minutes of MD or QHCP time or Clinical personnel time.  There is a great new table located in the CPT

book on page 68 for these codes that will help the coder in deciding what code to assign.

 

For Care Management Services, the introductory information for these codes have been updated and

revised.  These start on page 62 of the CPT book.   There is also a new table on page 65 to assist coders.

 

Chronic care management code 99491 was updated to reflect first 30 minutes provided, with add on

code 99437 added for each additional 30 minutes.

 

Code 90785 had additional language to clarify that 90785 requires a psychiatric diagnostic evaluation or

psychotherapy service and is not applicable to E/M alone. Nor is an E/M required. Removal of outdated

language regarding E/M level selection.

Removal of allowance for language translation. “Is not fluent in the same…”

Removal of some description of the typical patient. “These factors typically..”

               

               Conversion Factor for Physician Services CY2022

December 31, 2021 – $34.89

January 1, 2022 – $33.59

January 1, 2022 – A $1.30 decrease from CY2021

For CY 2022, CMS is clarifying and refining policies that were reflected in Medicare manual instructions that were recently withdrawn. Specifically, they are making a number of refinements to  current policies for split (or shared) E/M visits, critical care services, and services furnished by teaching physicians involving residents, telehealth services under PFS, therapy and vaccine services.

See final rule for specific changes. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched

https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2022-medicare-physician-fee-schedule-final-rule

 

Conversion Factor for HOPPS Hospitals CY2022

Overall INCREASE of payment rates of 2.0% for 2022 (2.7% increase reduced by 0.7 percentage point for the productivity adjustment)

Two conversion factors for CY 2022

For hospitals that meet the outpatient quality reporting (OQR) requirements, the 2022 conversion factor increases to $84.177 which is up from $82.797 from CY 2021.

Reduction of 2.0% in 2022 for those that fail to meet Hospital OQR requirement

 

Status Indicator C procedures

In 2021, CMS stated they were going to eliminate the IPO list over three years, removing 298 services from IPO list.  A large amount of comments were received and CMS is rescinding this change.

Procedures only paid in inpatient setting.

  • See Addendum E from final rule for a list of these.
  • Added back  all that were removed in 2021 except for 22630 (Lumbar spine fusion), 23472 (Reconstruct shoulder joint), 27702 (Reconstruct ankle joint) and their corresponding anesthesia codes.
The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly. 

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