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![• 0775T Arthrodesis, sacroiliac joint, percutaneous, with image
guidance, includes placement of intra-articular implant(s) (eg,
bone allograft[s], synthetic device[s])
• Unique method of stabilizing sacroilicac (SI) joint using a
distracting intra-articular implant placed between the two bony
surfaces of the iliac and sacral bones
• Tensioning accomplishes the stabilization
• Different work and different approach than 27279](https://image.slidesharecdn.com/vwdownload2022-12-15-2023cptupdates-physician-221229185144-3e34f922/75/2023-CPT-Code-Updates-Physician-Focused-18-2048.jpg)
![Revised Code 50080
•2023
•Percutaneous nephrolithotomy or
pyelolithotomy lithotripsy, stone
extraction, antegrade
ureteroscopy, antegrade stent
placement and nephrostomy tube
placement, when performed,
including imaging guidance;
simple (eg, stone[s] up to 2 cm in
single location of kidney or renal
pelvis, nonbranching stones)
•2022
•Percutaneous
nephrostolithotomy or
pyelostolithotomy, with or
without dilation, endoscopy,
lithotripsy, stenting, or basket
extraction up to 2 cm](https://image.slidesharecdn.com/vwdownload2022-12-15-2023cptupdates-physician-221229185144-3e34f922/75/2023-CPT-Code-Updates-Physician-Focused-56-2048.jpg)
![Revised Code 50081
•2023
•Percutaneous nephrolithotomy or
pyelolithotomy lithotripsy, stone
extraction, antegrade
ureteroscopy, antegrade stent
placement and nephrostomy tube
placement, when performed,
including imaging guidance;
complex (eg, stone[s] > 2 cm,
branching stones, stones in
multiple locations, ureter stones,
complicated anatomy)
•2022
•Percutaneous
nephrostolithotomy or
pyelostolithotomy, with or
without dilation, endoscopy,
lithotripsy, stenting, or basket
extraction, over 2 cm](https://image.slidesharecdn.com/vwdownload2022-12-15-2023cptupdates-physician-221229185144-3e34f922/75/2023-CPT-Code-Updates-Physician-Focused-57-2048.jpg)
![New Code
• 0776T Therapeutic induction of intra-brain hypothermia,
including placement of a mechanical temperature-controlled
cooling device to the neck over carotids and head, including
monitoring (eg, vital signs and sport concussion assessment
tool 5 [SCAT5]), 30 minutes of treatment
• For concussion, most likely a sports injury](https://image.slidesharecdn.com/vwdownload2022-12-15-2023cptupdates-physician-221229185144-3e34f922/75/2023-CPT-Code-Updates-Physician-Focused-66-2048.jpg)
![Ultrasound of Nerve
• Revised code 76882 Ultrasound, limited, joint or focal
evaluation of other nonvascular extremity structure(s) (eg,
joint space, peri-articular tendon[s], muscle[s], nerve[s], other
soft-tissue structure[s], or soft-tissue mass[es]), real-time with
image documentation
• New code 76883 Ultrasound, nerve(s) and accompanying
structures throughout their entire anatomic course in one
extremity, comprehensive, including real-time cine imaging
with image documentation, per extremity](https://image.slidesharecdn.com/vwdownload2022-12-15-2023cptupdates-physician-221229185144-3e34f922/75/2023-CPT-Code-Updates-Physician-Focused-77-2048.jpg)
![New PLA Codes
• 0361U Neurofilament light chain, digital immunoassay,
plasma, quantitative
• 0362U Oncology (papillary thyroid cancer), gene-expression
profiling via targeted hybrid capture–enrichment RNA
sequencing of 82 content genes and 10 housekeeping genes,
formalin-fixed paraffin embedded (FFPE) tissue, algorithm
reported as one of three molecular subtypes
• 0363U Oncology (urothelial), mRNA, gene-expression profiling
by real-time quantitative PCR of 5 genes (MDK, HOXA13,
CDC2 [CDK1], IGFBP5, and CXCR2), utilizing urine, algorithm
incorporates age, sex, smoking history, and macrohematuria
frequency, reported as a risk score for having urothelial
carcinoma](https://image.slidesharecdn.com/vwdownload2022-12-15-2023cptupdates-physician-221229185144-3e34f922/75/2023-CPT-Code-Updates-Physician-Focused-93-2048.jpg)
Uploaded byHealth Catalyst
2023 CPT® Code Updates (Physician Focused)
The document outlines the updates to Current Procedural Terminology (CPT®) codes for professional services effective January 1, 2023, covering changes across various medical specialties including surgery, radiology, and cardiology. Key revisions include new and revised codes reflecting advancements in treatment techniques and procedures, such as hernia repairs, arthrodesis, and pulmonary artery revascularization. The summary provides a detailed breakdown of added, deleted, and revised codes alongside their descriptions and classifications.
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2023 CPT® Code Updates (Physician Focused)
- 1. Current Procedural Terminology (CPT®) Updatesfor 2023 Professional Services Focus
- 4. Ardith Campbell COC, CPC Director,Product Content
- 5. Agenda • Summary ofCPT® changes effective January 1, 2023 • Not including codes released and already available for use • Sectional review of changes • Category III codes will be discussed within related section • CPT® code 0499T originally deactivated, but change rescinded
- 6.
- 7. Summary of Changes SectionAdded Deleted Revised Evaluation and Management (E/M) 1 26 50 Surgery 33 19 22 Radiology 1 0 5 Path/Lab 11 0 3 Medicine 10 0 7 Category III 46 22 2 Proprietary Laboratory Analysis (PLA) 9 0 0 Totals 111 67 89
- 8.
- 9. Surgical Sections 33 New,19 Deleted, 22 Revised
- 10.
- 11. Deleted & RevisedCodes • Deleted: 15850 Removal of sutures under anesthesia (other than local), same surgeon • Revised: 15851 • 2022 Removal of sutures under anesthesia (ie, general anesthesia, moderate sedation)(other than local), other surgeon • 2023 Removal of sutures or staples requiring anesthesia (ie, general anesthesia, moderate sedation)
- 12. New Codes CPT® Code Description 15778 Implantationof absorbable mesh or other prosthesis for delayed closure of defect(s) (ie, external genitalia, perineum, abdominal wall) due to soft tissue infection or trauma 15853 Removal of sutures or staples not requiring anesthesia (List separately in addition to E/M code) 15854 Removal of sutures and staples not requiring anesthesia (List separately in addition to E/M code)
- 13.
- 14. Revised Codes • 22630Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace, lumbar; • 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace, lumbar; • Both have the semi-colon at the end
- 15. Revised Codes • 22857Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression); single interspace, lumbar • 27280 Arthrodesis, sacroiliac joint, open, includes obtaining bone graft, including instrumentation, when performed
- 16. New Code • 22860Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression); second interspace, lumbar (List separately in addition to code for primary procedure) • Replaces 0163T • Two or more interspaces treated, use the unlisted code 22899
- 17.
- 18. • 0775T Arthrodesis,sacroiliac joint, percutaneous, with image guidance, includes placement of intra-articular implant(s) (eg, bone allograft[s], synthetic device[s]) • Unique method of stabilizing sacroilicac (SI) joint using a distracting intra-articular implant placed between the two bony surfaces of the iliac and sacral bones • Tensioning accomplishes the stabilization • Different work and different approach than 27279
- 19.
- 20. Surface Mechanomyography • 0778TSurface mechanomyography (sMMG) with concurrent application of inertial measurement unit (IMU) sensors for measurement of multi-joint range of motion, posture, gait, and muscle function • To report measurement and recording of dynamic joint motion and muscle function • Not a remote service
- 21. Respiratory System CPT® Codes30000-32999
- 22. New Code • 30469Repair of nasal valve collapse with low energy, temperature-controlled (ie, radiofrequency) subcutaneous/submucosal remodeling
- 23.
- 24. Revised Code -35883 •2023 •Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with nonautogenous patch graft (eg, polyester, ePTFE, bovine pericardium) •2022 •Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with nonautogenous patch graft (eg, Dacron, ePTFE, bovine pericardium)
- 25. New Codes CPT® Code Description 36836 Percutaneousarteriovenous fistula creation, upper extremity, single access of both the peripheral artery and peripheral vein, including fistula maturation procedures (eg, transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation 36837 Percutaneous arteriovenous fistula creation, upper extremity, separate access sites of the peripheral artery and peripheral vein, including fistula maturation procedures (eg, transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation
- 26. Percutaneous Arteriorvenous (AV) FistulaCreation • 36836 single access site, usually via arm vein • 36837 two separate access sites into peripheral artery & vein • Use unlisted code for lower extremity
- 27. New Codes CPT® CodeDescription 33900 Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections, unilateral 33901 Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections, bilateral 33902 Percutaneous pulmonary artery revascularization by stent placement, initial; abnormal connections, unilateral 33903 Percutaneous pulmonary artery revascularization by stent placement, initial; abnormal connections, bilateral 33904 Percutaneous pulmonary artery revascularization by stent placement, each additional vessel or separate lesion, normal or abnormal connections (List separately in addition to code for primary procedure)
- 28. Different Codes BasedOn Normal Connections Abnormal Connections Unilateral Stent 33900 33902 Bilateral Stent 33901 33903 Additional Stent 33904 33904 Code 33904 to report stent placement in additional pulmonary arteries or a separate lesion in the same pulmonary artery
- 29. Abnormal Connections • Blalock-TaussigShunt • Subclavian artery to pulmonary artery (PA) shunt • Sano Shunt • Extracardiac conduit between the right ventricle and main PA stump • Used as a step in the Norwood procedure for hypoplastic left heart syndrome • Glenn Shunt • Variation of a superior vena cava to PA shunt
- 30. Guidelines • Balloon angioplasty(92997, 92998) within same target lesion not separately reported • Either before or after stent deployment • Diagnostic cardiac catheterization and diagnostic angiography codes (93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93563, 93566, 93567, 93568, 93593, 93594, 93596, 93597, 93598) should not be used with 33900, 33901, 33902, 33903, 33904 to report: • Contrast injections, angiography, roadmapping , and/or fluoroscopic guidance for the TPVI, • Pulmonary conduit angiography for guidance of TPVI, or • Right heart catheterization for hemodynamic measurements before, during, and after TPVI for guidance of TPVI.
- 31.
- 32. Absolute Quantification Myocardial BloodFlow (AQBMF) • 0742T Absolute quantitation of myocardial blood flow (AQMBF), single-photon emission computed tomography (SPECT), with exercise or pharmacologic stress, and at rest, when performed (List separately in addition to code for primary procedure) • Detects reduced coronary flow reserve • Identifies patients with high-risk coronary artery disease
- 33. Bioprosthetic Venous Valve •0744T Insertion of bioprosthetic valve, open, femoral vein, including duplex ultrasound imaging guidance, when performed, including autogenous or nonautogenous patch graft (eg, polyester, ePTFE, bovine pericardium), when performed • Includes imaging guidance using duplex ultrasound • Support blood flow from lower extremities despite absence of native deep venous valvular function
- 34. Cardiac Functional Radioablation CPT®Code Description 0745T Cardiac focal ablation utilizing radiation therapy for arrhythmia; noninvasive arrhythmia localization and mapping of arrhythmia site (nidus), derived from anatomical image data (eg, CT, MRI, or myocardial perfusion scan) and electrical data (eg, 12-lead ECG data), and identification of areas of avoidance 0746T Cardiac focal ablation utilizing radiation therapy for arrhythmia; conversion of arrhythmia localization and mapping of arrhythmia site (nidus) into a multidimensional radiation treatment plan 0747T Cardiac focal ablation utilizing radiation therapy for arrhythmia; delivery of radiation therapy, arrhythmia
- 35. Digestive System CPT® Codes40000-49999
- 36.
- 37. New Codes • 43290Esophagogastroduodenoscopy, flexible, transoral; with deployment of intragastric bariatric balloon • 43291 Esophagogastroduodenoscopy, flexible, transoral; with removal of intragastric bariatric balloon(s)
- 38.
- 39. Fecal Microbiota, Bronchoscopy •0780T Instillation of fecal microbiota suspension via rectal enema into lower gastrointestinal tract • Describes a regulated live biotherapeutic agent • 0781T Bronchoscopy, rigid or flexible, with insertion of esophageal protection device and circumferential radiofrequency destruction of the pulmonary nerves, including fluoroscopic guidance when performed; bilateral mainstem bronchi • 0782T Bronchoscopy, rigid or flexible, with insertion of esophageal protection device and circumferential radiofrequency destruction of the pulmonary nerves, including fluoroscopic guidance when performed; unilateral mainstem bronchus
- 40. Myoelectrical Study • 0779TGastrointestinal myoelectrical activity study, stomach through colon, with interpretation and report • Noninvasive procedure to assess motility in the GI tract from stomach through the colon • Other codes do not assess motility all the way through • 91020 only measures motility of stomach • 91022 only measures motility of duodenum
- 41.
- 42. Deleted Codes CPT® CodeShort Description Suggested Replacement(s) 49560 RPR VENTRAL HERN INIT REDUC 49591, 49593, 49595 49561 RPR VENTRAL HERN INIT BLOCK 49592, 49594, 49596 49565 REREPAIR VENTRL HERN REDUCE 49613, 49615, 49617 49566 REREPAIR VENTRL HERN BLOCK 49614, 49616, 49618 49568 HERNIA REPAIR W/MESH 49591, 49592, 49593, 49594, 49596, 49613, 49614, 49615, 49616, 49617, 49618 49570 RPR EPIGASTRIC HERN REDUCE 49591, 49593, 49595, 49613, 49615, 49617 49572 RPR EPIGASTRIC HERN BLOCKED 49592, 49594, 49596, 49614, 49616, 49618 49580 RPR UMBIL HERN REDUC < 5 YR 49591, 49593, 49595, 49613, 49615, 49617 49582 RPR UMBIL HERN BLOCK < 5 YR 49592, 49594, 49596, 49614, 49616, 49618 49585 RPR UMBIL HERN REDUC > 5 YR 49591, 49593, 49595, 49613, 49615, 49617 49587 RPR UMBIL HERN BLOCK > 5 YR 49592, 49594, 49596, 49614, 49616, 49618
- 43. Deleted Codes CPT® CodeShort Description Suggested Replacement(s) 49590 REPAIR SPIGELIAN HERNIA 49591, 49592, 49593, 49594, 49595, 49596, 49613, 49614, 49615, 49616, 49617, 49618 49652 LAP VENT/ABD HERNIA REPAIR 49591, 49593, 49595, 49613, 49615, 49617 49653 LAP VENT/ABD HERN PROC COMP 49592, 49594, 49596, 49614, 49616, 49618 49654 LAP INC HERNIA REPAIR 49591, 49593, 49595 49655 LAP INC HERN REPAIR COMP 49592, 49594, 49596 49656 LAP INC HERNIA REPAIR RECUR 49613, 49615, 49617 49657 LAP INC HERN RECUR COMP 49614, 49616, 49618
- 44. Overview • Codes 49591-49596initial repair of a reducible, incarcerated or strangulated anterior abdominal hernia < 3cm to > 10cm • Codes 49613-49618 recurrent repair of a reducible, incarcerated or strangulated anterior abdominal hernia < 3cm to > 10cm • Codes 49621-49622 initial or recurrent repair of a reducible, incarcerated or strangulated parastomal hernia • Code 49623 removal of total or near total non-infected mesh or other prosthesis during anterior abdominal or parastomal hernia repair
- 45. Coding Help Type SizeSeverity CPT® Code Initial < 3 cm Reducible Incarcerated/Strangulated 49591 49592 Recurrent < 3 cm Reducible Incarcerated/Strangulated 49613 49614 Initial 3 cm to 10 cm Reducible Incarcerated/Strangulated 49593 49594 Recurrent 3 cm to 10 cm Reducible Incarcerated/Strangulated 49615 49616 Initial > 10 cm Reducible Incarcerated/Strangulated 49595 49596 Recurrent > 10 cm Reducible Incarcerated/Strangulated 49617 49618
- 46. New codes CPT® CodeDescription 49591 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, reducible 49592 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, incarcerated or strangulated 49593 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, reducible
- 47. New Codes CPT® CodeDescription 49594 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, incarcerated or strangulated 49595 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); greater than 10 cm, reducible 49596 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); greater than 10 cm, incarcerated or strangulated
- 48. New Codes CPT® CodeDescription 49613 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, reducible 49614 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, incarcerated or strangulated 49615 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, reducible
- 49. New Codes CPT® CodeDescription 49616 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, incarcerated or strangulated 49617 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); greater than 10 cm, reducible 49618 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); greater than 10 cm, incarcerated or strangulated
- 50. New Codes CPT® CodeDescription 49621 Repair of parastomal hernia, any approach (ie, open, laparoscopic, robotic), initial or recurrent, including implantation of mesh or other prosthesis, when performed; reducible 49622 Repair of parastomal hernia, any approach (ie, open, laparoscopic, robotic), initial or recurrent, including implantation of mesh or other prosthesis, when performed; incarcerated or strangulated 49623 Removal of total or near total non-infected mesh or other prosthesis at the time of initial or recurrent anterior abdominal hernia repair or parastomal hernia repair, any approach (ie, open, laparoscopic, robotic) (List separately in addition to code for primary procedure)
- 51. Hernia Repair • Reportonce, based on the total defect size • Measure prior to opening the defect • The fascia typically retracts • Measure as the maximal craniocaudal or transverse distance between the outer margins of all defects repaired • “Swiss cheese” defects measured from superior most aspect of the upper defect to the inferior most aspect of the lowest defect
- 52. Hernia Repair • Whenboth reducible and incarcerated or strangulated hernias repaired at the same operative session, all hernias are reported as incarcerated or strangulated • Example: one 2 cm reducible initial incisional hernia and one 4 cm incarcerated initial incisional hernia separated by 2 cm would be reported with a maximum craniocaudal distance of 8 cm (49594) • Inguinal, femoral, lumbar, omphalocele and/or parastomal hernia repair may be reported separately • Mesh or other prosthesis included in 49521-49622
- 53.
- 54. New Code • 0748TInjections of stem cell product into perianal perifistular soft tissue, including fistula preparation (eg, removal of setons, fistula curettage, closure of internal openings) • Report stem cell product separately
- 55. Urinary System CPT® Codes50000-53999
- 56. Revised Code 50080 •2023 •Percutaneousnephrolithotomy or pyelolithotomy lithotripsy, stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guidance; simple (eg, stone[s] up to 2 cm in single location of kidney or renal pelvis, nonbranching stones) •2022 •Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction up to 2 cm
- 57. Revised Code 50081 •2023 •Percutaneousnephrolithotomy or pyelolithotomy lithotripsy, stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guidance; complex (eg, stone[s] > 2 cm, branching stones, stones in multiple locations, ureter stones, complicated anatomy) •2022 •Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction, over 2 cm
- 58. Male Genital System CPT®Codes 54000-55999
- 59. New Code • 55867Laparoscopy, surgical prostatectomy, simple subtotal (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy), includes robotic assistance, when performed
- 60. Magnetic Field Induction Malignant ProstateTissue Category III
- 61. Ablation of MalignantProstate Tissue CPT® Code Description 0738T Treatment planning for magnetic field induction ablation of malignant prostate tissue, using data from previously performed magnetic resonance imaging (MRI) examination 0739T Ablation of malignant prostate tissue by magnetic field induction, including all intraprocedural, transperineal needle/catheter placement for nanoparticle installation and intraprocedural temperature monitoring, thermal dosimetry, bladder irrigation, and magnetic field nanoparticle activation
- 62. Nervous System CPT® Codes61000-64999
- 63. Revised Codes • 64415-64417,64445-64448 adding including imaging guidance, when performed • Example: 64415 Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, including imaging guidance, when performed
- 64. Revised Guidelines –64490-64495 ►Codes 64490, 64491, 64492, 64493, 64494, 64495 describe the introduction/injection of a diagnostic or therapeutic agent into the paravertebral facet joint or into the nerves that innervate that joint by level. Facet joints are paired joints with one pair at each vertebral level. Imaging guidance and localization are required for the performance of paravertebral facet joint injections described by 64490, 64491, 64492, 64493, 64494, 64495. If imaging is not used, report 20552, 20553. If ultrasound guidance is used, report 0213T, 0214T, 0215T, 0216T, 0217T, 0218T. ◄ ►When determining a level, count the number of facet joints injected, not the number of nerves injected. Therefore, if multiple nerves of the same facet joint are injected, it would be considered as a single level. The add on codes are reported when second, third, or additional levels are injected during the same session. ◄
- 65.
- 66. New Code • 0776TTherapeutic induction of intra-brain hypothermia, including placement of a mechanical temperature-controlled cooling device to the neck over carotids and head, including monitoring (eg, vital signs and sport concussion assessment tool 5 [SCAT5]), 30 minutes of treatment • For concussion, most likely a sports injury
- 67.
- 68. Transcutaneous Magnetic Stimulation CPT®Code Description 0766T Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse, peripheral nerve, initial treatment, with identification and marking of the treatment location, including noninvasive electroneurographic localization (nerve conduction localization), when performed; first nerve 0767T Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse, peripheral nerve, initial treatment, with identification and marking of the treatment location, including noninvasive electroneurographic localization (nerve conduction localization), when performed; each additional nerve (List separately in addition to code for primary procedure) 0768T Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse, peripheral nerve, subsequent treatment, including noninvasive electroneurographic localization (nerve conduction localization), when performed; first nerve 0769T Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse, peripheral nerve, subsequent treatment, including noninvasive electroneurographic localization (nerve conduction localization), when performed; each additional nerve (List separately in addition to code for primary procedure)
- 69. Eye and Ocular Adnexa CPT®Codes 65000-68999
- 70. Revised codes • 66174Transluminal dilation of aqueous outflow canal (eg, canaloplasty); without retention of device or stent • 66175 Transluminal dilation of aqueous outflow canal (eg, canaloplasty); with retention of device or stent • Aligns with U.S. Food & Drug Administration (FDA) terminology for approved form of transluminal dilation of aqueous outflow canal
- 71. Auditory System CPT® Codes69000-69999
- 72. Revised Code 69716 •2023 •Implantation,osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or resulting in removal of less than 100 sq mm surface area of bone deep to the outer cranial cortex •2022 •Implantation, osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor
- 73. Revised Codes • RemoveRevision or at the beginning of codes 69717 & 69719 • 69717 Replacement (including removal of existing device), osseointegrated implant, skull; with percutaneous attachment to external speech processor • 69719 Replacement (including removal of existing device), osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or involving a bony defect less than 100 sq mm surface area of bone deep to the outer cranial cortex • 69726 Removal, entire osseointegrated implant, skull; with percutaneous attachment to external speech processor
- 74. Revised Code 69727 •2023 •Removal,entire osseointegrated implant, with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or involving a bony defect less than 100 sq mm surface area of bone deep to the outer cranial cortex •2022 •Removal, osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor
- 75. New Codes CPT® CodeDescription 69728 Removal, entire osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside the mastoid and involving a bony defect greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex 69729 Implantation, osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside of the mastoid and resulting in removal of greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex 69730 Replacement (including removal of existing device), osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside the mastoid and involving a bony defect greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex
- 76.
- 77. Ultrasound of Nerve •Revised code 76882 Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft-tissue structure[s], or soft-tissue mass[es]), real-time with image documentation • New code 76883 Ultrasound, nerve(s) and accompanying structures throughout their entire anatomic course in one extremity, comprehensive, including real-time cine imaging with image documentation, per extremity
- 78. Revised Codes • 78803Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT), single area (eg, head, neck, chest, pelvis), or acquisition, single day imaging • 78830 Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, single area (eg, head, neck, chest, pelvis), or acquisition, single day imaging
- 79. Revised Codes • 78831Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT), minimum 2 areas (eg, pelvis and knees, chest and abdomen) or separate acquisitions (eg, lung ventilation and perfusion), single day imaging, or single area or acquisition over 2 or more days • 78832 Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, minimum 2 areas (eg, pelvis and knees, chest and abdomen) or separate acquisitions (eg, lung ventilation and perfusion), single day imaging, or single area or acquisition over 2 or more days
- 80. Rationale • Did notidentify “acquisitions” • Separately obtained images with different radiopharmaceuticals, even if they were obtained on the same day and from the same anatomic site • Allows for more specific reporting • Allows for better differentiation when reporting codes 78831 & 78832
- 81. Bone Strength and FractureRisk Category III
- 82. Bone Strength andFracture Risk CPT® Code Description 0743T Bone strength and fracture risk using finite element analysis of functional data and bone mineral density (BMD), with concurrent vertebral fracture assessment, utilizing data from a computed tomography scan, retrieval and transmission of the scan data, measurement of bone strength and BMD and classification of any vertebral fractures, with overall fracture-risk assessment, interpretation and report 0749T Bone strength and fracture-risk assessment using digital X-ray radiogrammetry-bone mineral density (DXR-BMD) analysis of bone mineral density (BMD) utilizing data from a digital X ray, retrieval and transmission of digital X-ray data, assessment of bone strength and fracture risk and BMD, interpretation and report 0750T Bone strength and fracture-risk assessment using digital X-ray radiogrammetry-bone mineral density (DXR-BMD) analysis of bone mineral density (BMD) utilizing data from a digital X ray, retrieval and transmission of digital X-ray data, assessment of bone strength and fracture risk and BMD, interpretation and report; with single-view digital X- ray examination of the hand taken for the purpose of DXR-BMD
- 83.
- 84. Revised Code 81445 •2023 •Targetedgenomic sequence analysis panel, solid organ neoplasm, 5-50 genes (eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, MET, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed; DNA analysis or combined DNA and RNA analysis •2022 •Targeted genomic sequence analysis panel, solid organ neoplasm, DNA analysis, and RNA analysis when performed, 5-50 genes (eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, NRAS, MET, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed
- 85. Revised Code 81450 •2023 •Targetedgenomic sequence analysis panel, hematolymphoid neoplasm or disorder, 5-50 genes (eg, BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NOTCH1, NPM1, NRAS), interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; DNA analysis or combined DNA and RNA analysis •2022 •Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, DNA analysis, and RNA analysis when performed, 5-50 genes (eg, BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2, JAK2, KRAS, KIT, MLL, NRAS, NPM1, NOTCH1), interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed
- 86. Revised Code 81455 •2023 •Targetedgenomic sequence analysis panel, solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes (eg, ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MET, MLL, NOTCH1, NPM1, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; DNA analysis or combined DNA and RNA analysis •2022 •Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm, DNA analysis, and RNA analysis when performed, 51 or greater genes (eg, ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NPM1, NRAS, MET, NOTCH1, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed
- 87. New Codes CPT® CodeDescription 81418 Drug metabolism (eg, pharmacogenomics) genomic sequence analysis panel, must include testing of at least 6 genes, including CYP2C19, CYP2D6, and CYP2D6 duplication/deletion analysis 81441 Inherited bone marrow failure syndromes (IBMFS) (eg, Fanconi anemia, dyskeratosis congenita, Diamond-Blackfan anemia, Shwachman-Diamond syndrome, GATA2 deficiency syndrome, congenital amegakaryocytic thrombocytopenia) sequence analysis panel, must include sequencing of at least 30 genes, including BRCA2, BRIP1, DKC1, FANCA, FANCB, FANCC, FANCD2, FANCE, FANCF, FANCG, FANCI, FANCL, GATA1, GATA2, MPL, NHP2, NOP10, PALB2, RAD51C, RPL11, RPL35A, RPL5, RPS10, RPS19, RPS24, RPS26, RPS7, SBDS, TERT, and TINF2 81449 Targeted genomic sequence analysis panel, solid organ neoplasm, 5-50 genes (eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, MET, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed; RNA analysis
- 88. New Codes CPT® CodeDescription 81451 Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, 5- 50 genes (eg, BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NOTCH1, NPM1, NRAS), interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis 81456 Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes (eg, ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MET, MLL, NOTCH1, NPM1, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis 84433 Thiopurine S-methyltransferase (TPMT)
- 89. New Codes CPT® CodeDescription 87467 Hepatitis B surface antigen (HBsAg), quantitative 87468 Infectious agent detection by nucleic acid (DNA or RNA); Anaplasma phagocytophilum, amplified probe technique 87469 Infectious agent detection by nucleic acid (DNA or RNA); Babesia microti, amplified probe technique 87478 Infectious agent detection by nucleic acid (DNA or RNA); Borrelia miyamotoi, amplified probe technique 87484 Infectious agent detection by nucleic acid (DNA or RNA); Ehrlichia chaffeensis, amplified probe technique
- 90.
- 91. New PLA Codes •0355U APOL1 (apolipoprotein L1) (eg, chronic kidney disease), risk variants (G1, G2) • 0356U Oncology (oropharyngeal), evaluation of 17 DNA biomarkers using droplet digital PCR (ddPCR), cell-free DNA, algorithm reported as a prognostic risk score for cancer recurrence • 0357U Oncology (melanoma), artificial intelligence (AI)- enabled quantitative mass spectrometry analysis of 142 unique pairs of glycopeptide and product fragments, plasma, prognostic, and predictive algorithm reported as likely, unlikely, or uncertain benefit from immunotherapy agents
- 92. New PLA Codes •0358U Neurology (mild cognitive impairment), analysis of β- amyloid 1-42 and 1-40, chemiluminescence enzyme immunoassay, cerebral spinal fluid, reported as positive, likely positive, or negative • 0359U Oncology (prostate cancer), analysis of all prostate- specific antigen (PSA) structural isoforms by phase separation and immunoassay, plasma, algorithm reports risk of cancer • 0360U Oncology (lung), enzyme-linked immunosorbent assay (ELISA) of 7 autoantibodies (p53, NY-ESO-1, CAGE, GBU4-5, SOX2, MAGE A4, and HuD), plasma, algorithm reported as a categorical result for risk of malignancy
- 93. New PLA Codes •0361U Neurofilament light chain, digital immunoassay, plasma, quantitative • 0362U Oncology (papillary thyroid cancer), gene-expression profiling via targeted hybrid capture–enrichment RNA sequencing of 82 content genes and 10 housekeeping genes, formalin-fixed paraffin embedded (FFPE) tissue, algorithm reported as one of three molecular subtypes • 0363U Oncology (urothelial), mRNA, gene-expression profiling by real-time quantitative PCR of 5 genes (MDK, HOXA13, CDC2 [CDK1], IGFBP5, and CXCR2), utilizing urine, algorithm incorporates age, sex, smoking history, and macrohematuria frequency, reported as a risk score for having urothelial carcinoma
- 94. Digitization of Slides CategoryIII Codes
- 95. New Cat IIICodes • 0751T Digitization of glass microscope slides for level II, surgical pathology, gross and microscopic examination (List separately in addition to code for primary procedure) • 0752T Digitization of glass microscope slides for level III, surgical pathology, gross and microscopic examination (List separately in addition to code for primary procedure) • 0753T Digitization of glass microscope slides for level IV, surgical pathology, gross and microscopic examination (List separately in addition to code for primary procedure)
- 96. New Cat IIICodes • 0754T Digitization of glass microscope slides for level V, surgical pathology, gross and microscopic examination (List separately in addition to code for primary procedure) • 0755T Digitization of glass microscope slides for level VI, surgical pathology, gross and microscopic examination (List separately in addition to code for primary procedure) • 0756T Digitization of glass microscope slides for special stain, including interpretation and report, group I, for microorganisms (eg, acid fast, methenamine silver) (List separately in addition to code for primary procedure)
- 97. New Cat IIICodes • 0757T Digitization of glass microscope slides for special stain, including interpretation and report, group II, all other (eg, iron, trichrome), except stain for microorganisms, stains for enzyme constituents, or immunocytochemistry and immunohistochemistry (List separately in addition to code for primary procedure) • 0758T Digitization of glass microscope slides for special stain, including interpretation and report, histochemical stain on frozen tissue block (List separately in addition to code for primary procedure)
- 98. New Cat IIICodes • 0759T Digitization of glass microscope slides for special stain, including interpretation and report, group III, for enzyme constituents (List separately in addition to code for primary procedure) • 0760T Digitization of glass microscope slides for immunohistochemistry or immunocytochemistry, per specimen, initial single antibody stain procedure (List separately in addition to code for primary procedure) • 0761T Digitization of glass microscope slides for immunohistochemistry or immunocytochemistry, per specimen, each additional single antibody stain procedure (List separately in addition to code for primary procedure)
- 99. New Cat IIICodes • 0762T Digitization of glass microscope slides for immunohistochemistry or immunocytochemistry, per specimen, each multiplex antibody stain procedure (List separately in addition to code for primary procedure) • 0763T Digitization of glass microscope slides for morphometric analysis, tumor immunohistochemistry (eg, Her- 2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure, manual (List separately in addition to code for primary procedure)
- 100. Medicine 10 New, 7Revised
- 101. New Vaccine Code •90678 Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use • Pfizer’s RSVpreF vaccine • Submitting a biologics license application (BLA) by end of year • Watch for U.S. Food & Drug Administration (FDA) approval next year
- 102. Orthoptic Training • Revised92065 Orthoptic training; performed by a physician or other qualified health care professional • New code 92066 Orthoptic training; under supervision of a physician or other qualified health care professional
- 103. The Eyes HaveIt • Revised code 92229 Imaging of retina for detection or monitoring of disease; point-of-care autonomous analysis and report, unilateral or bilateral • Revised code 92284 Diagnostic dark adaptation examination with interpretation and report • New code 95919 Quantitative pupillometry with physician or other qualified health care professional interpretation and report, unilateral or bilateral
- 104. Injection Procedure During CardiacCath CPT® Codes 93568-93575
- 105. One Revised, FourNew Codes CPT® Code Description 93568 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for nonselective pulmonary arterial angiography (List separately in addition to code for primary procedure) 93569 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, unilateral (List separately in addition to code for primary procedure) 93573 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, bilateral (List separately in addition to code for primary procedure)
- 106. One Revised, FourNew Codes CPT® Code Description 93574 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary venous angiography of each distinct pulmonary vein during cardiac catheterization (List separately in addition to code for primary procedure) 93575 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary angiography of major aortopulmonary collateral arteries (MAPCAs) arising off the aorta or its systemic branches, during cardiac catheterization for congenital heart defects, each distinct vessel (List separately in addition to code for primary procedure)
- 107. Caregiver Behavior Management CPT® Codes96202-96203
- 108. Two New Codes •96202 Multiple-family group behavior management/modification training for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of parent(s)/guardian(s)/caregiver(s); initial 60 minutes • 96203 Multiple-family group behavior management/modification training for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of parent(s)/guardian(s)/caregiver(s); each additional 15 minutes (List separately in addition to code for primary service)
- 109. Cognitive Behavioral Therapy Monitoring CPT®Codes 98975-98978
- 110. Three Revised Codes,One New • Revised codes 98975-98977 • 2022 Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); • 2023 Remote therapeutic monitoring (eg, therapy adherence, therapy response); • New code 98978 Remote therapeutic monitoring (eg, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor cognitive behavioral therapy, each 30 days
- 111.
- 112. Transcutaneous Auricular Neurostimulation • 0783TTranscutaneous auricular neurostimulation, set-up, calibration, and patient education on use of equipment • Sends electrical stimulation to the vagus and trigeminal nerves • Aids in the relief of opioid-withdrawal symptoms
- 113.
- 114. Revised Code –0733T •2023 •Remote real-time, motion capture–based neurorehabilitative therapy ordered by a physician or other qualified health care professional; supply and technical support, per 30 days •2022 •Remote body and limb kinematic measurement-based therapy ordered by a physician or other qualified health care professional; supply and technical support, per 30 days
- 115. Revised Code –0734T •2023 •Remote real-time, motion capture–based neurorehabilitative therapy ordered by a physician or other qualified health care professional; treatment management services by a physician or other qualified health care professional, per calendar month •2022 •Remote body and limb kinematic measurement-based therapy ordered by a physician or other qualified health care professional; treatment management services by a physician or other qualified health care professional, per calendar month
- 116. Artificial Intelligence (AI)Insulin Dose CPT® Code Description 0740T Remote autonomous algorithm-based recommendation system for insulin dose calculation and titration; initial set-up and patient education 0741T Remote autonomous algorithm-based recommendation system for insulin dose calculation and titration; provision of software, data collection, transmission, and storage, each 30 days Technology provides the appropriate adjusted insulin dose in real time
- 117. AI Cardiac FunctionServices CPT® Code Description 0764T Assistive algorithmic electrocardiogram risk-based assessment for cardiac dysfunction (eg, low-ejection fraction, pulmonary hypertension, hypertrophic cardiomyopathy); related to concurrently performed electrocardiogram (List separately in addition to code for primary procedure) 0765T Assistive algorithmic electrocardiogram risk-based assessment for cardiac dysfunction (eg, low-ejection fraction, pulmonary hypertension, hypertrophic cardiomyopathy); related to previously performed electrocardiogram EKG is software analysis (algorithm is run to look for dx in description of code) Code selection based on whether concurrent with electrocardiogram tracing.
- 118. AI Epidural Placement •0777T Real-time pressure-sensing epidural guidance system (List separately in addition to code for primary procedure) • Software analyzes epidural pressure to detail anatomical needle placement • Measures precise saline volume • Report in conjunction with CPT® codes 62320-62327
- 119. Virtual-Reality (VR) MediatedTherapy • 0770T Virtual reality technology to assist therapy (List separately in addition to code for primary procedure) • Used for skill building in • Social communication • Emotional regulation • Daily functions • This is practice expense and coded once per therapy session • Watch parenthetical notes
- 120. VR Procedural DissociationServices • VR-based state of altered consciousness • Supports and optimizes patient comfort • Increases procedural tolerance • Decreases pain • Computer-generated audio, visual proprioceptive environment • Can still respond to verbal commands, maybe with light tactile stimulation • Does not involve interventions to maintain cardiovascular function, patent airway, or spontaneous ventilation
- 121. VR Procedural DissociationServices CPT® Code Description 0771T Virtual reality (VR) procedural dissociation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the VR procedural dissociation supports, requiring the presence of an independent, trained observer to assist in the monitoring of the patient's level of dissociation or consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older 0772T Virtual reality (VR) procedural dissociation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the VR procedural dissociation supports, requiring the presence of an independent, trained observer to assist in the monitoring of the patient's level of dissociation or consciousness and physiological status; each additional 15 minutes intraservice time (List separately in addition to code for primary service)
- 122. VR Procedural DissociationServices CPT® Code Description 0773T Virtual reality (VR) procedural dissociation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the VR procedural dissociation supports; initial 15 minutes of intraservice time, patient age 5 years or older 0774T Virtual reality (VR) procedural dissociation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the VR procedural dissociation supports; each additional 15 minutes intraservice time (List separately in addition to code for primary service) Not used for services under 10 minutes Patient must be 5 years of age or older
- 123. Evaluation and Management (E/M) OtherE/M Codes take on 2021 Updates
- 124. Overview of Updates •Evaluation and Management (E/M) Introductory Guidelines • Hospital Inpatient and Observation Care Services codes 99221- 99223, 99231-99239 • Consultations codes 99242-99245, 99252-99255, • Emergency Department Services codes 99281-99285, • Nursing Facility Services codes 99304-99310, 99315, 99316, • Home or Residence Services codes 99341, 99342, 99344, 99345, 99347-99350
- 125. Overview of Updates •Deletion of Hospital Observation Services E/M codes 99217- 99220 • Revision of Hospital Inpatient and Observation Care Services E/M codes 99221-99223, 99231-99239 and guidelines • Deletion of Consultations E/M codes 99241 and 99251 • Revision of Consultations E/M codes 99242-99245, 99252- 99255 and guidelines
- 126. Overview of Updates •Revision of Emergency Department Services E/M codes 99281-99285 and guidelines • Deletion of Nursing Facility Services E/M code 99318 • Revision of Nursing Facility Services E/M codes 99304-99310, 99315, 99316 and guidelines • Deletion of Domiciliary, Rest Home (eg, Boarding Home), or Custodial Care Services E/M codes 99324-99238, 99334- 99337, 99339, 99340
- 127. Overview of Updates •Deletion of Home or Residence Services E/M code 99343 • Revision of Home or Residence Services E/M codes 99341, 99342, 99344, 99345, 99347-99350 and guidelines • Deletion of Prolonged Services E/M codes 99354-99357 • Revision of guidelines for Prolonged Services E/M codes 99358, 99359, 99415, 99416 • Revision of Prolonged Services E/M code 99417 and guidelines • Establishment of Prolonged Services E/M code 99418 and guidelines
- 128. Levels of E/MServices • No longer based on examination • Medically appropriate history and/or physical examination, when performed • Extent of history & exam is not an element used in selection of E/M • Levels of E/M selection • Based on the level of Medical Decision Making (MDM) OR • Total time for E/M services performed on the date of the encounter • Minimal Updates to MDM Table
- 129. Hospital Inpatient and Observation Services HospIP/Obsv Services
- 130. Observation Care Deletions •Initial hospital care codes revised to include observation CPT® Code Description Suggested Replacement(s) 99217 OBSERVATION CARE DISCHARGE 99238, 99239 99218 INITIAL OBSERVATION CARE 99221, 99222, 99223 99219 INITIAL OBSERVATION CARE 99221, 99222, 99223 99220 INITIAL OBSERVATION CARE 99221, 99222, 99223 99224 SUBSEQUENT OBSERVATION CARE 99231, 99232, 99233 99225 SUBSEQUENT OBSERVATION CARE 99231, 99232, 99233 99226 SUBSEQUENT OBSERVATION CARE 99231, 99232, 99233
- 131. Initial Hospital orObservation Care CPT® Code Revised Description 99221 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. 99222 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded. 99223 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.
- 132. Subsequent Hospital Inpatientor Observation Care CPT® Code Revised Description 99231 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded. 99232 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded. 92233 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.
- 133. Revised Admit/Discharge onthe Same Day CPT® Code Revised Description 99234 Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. 99235 Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and moderate level of medical decision. When using total time on the date of the encounter for code selection, 70 minutes must be met or exceeded. 99236 Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and high level of medical decision. When using total time on the date of the encounter for code selection, 85 minutes must be met or exceeded.
- 134. Revised Hospital DischargeDay Management CPT® Code Revised Description 99238 Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter 99239 Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter
- 135.
- 136. Deleted Consultation Codes CPT®Code Short Description Suggested Replacement(s) 99241 OFFICE CONSULTATION 99242, 99243, 99244, 99245 99251 INPATIENT CONSULTATION 99252, 99253, 99254, 99255
- 137. Initial and SubsequentServices • Some categories may apply to both new or established patients (hospital inpatient or observation care) • Initial service is when the patient has not received any professional services from the physician or QHP of the exact same specialty/subspecialty in the same group practice during the inpatient, observation or nursing facility admission and stay • Subsequent service reported when the patient has received professional services from the physician or QHP of the exact same specialty/subspecialty in the same group practice during the inpatient, observation or nursing facility admission and stay
- 138. Initial and SubsequentServices • If provider is on call, the patient’s encounter is classified as if the unavailable physician or QHP provided the visit • When QHPs are working with physicians, they are considered as working in the exact same specialty and subspecialty • Single stay • Inpatient or observation services that transition to inpatient • Skilled nursing facility level of care transitions to nursing facility level of care
- 139. Revised Office orOther Outpatient Consultation CPT® Code Revised Description 99242 Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met of exceeded. 99243 Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met of exceeded. 99244 Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection,40 minutes must be met of exceeded. 99245 Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met of exceeded.
- 140. Revised Inpatient/Obsv Consultation CPT®Code Revised Description 99252 Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded. 99253 Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. 99254 Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. 99255 Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 80 minutes must be met or exceeded.
- 141.
- 142. Revised ED Visits CPT®Code Revised Description 99281 Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional 99282 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. 99283 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making.
- 143. Revised ED Visits CPT®Code Revised Description 99284 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. 99285 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making.
- 144. Documentation Tips • Reviewof external notes (nursing home, emergency medical services, discharge summary) • Independent historian (parent, guardian, spouse) • Independent interpretation of test (EKG, x-ray, CT scan) • Decision regarding hospitalization • Testing considered but not performed (CT scan) • Treatment considered but not performed (antibiotics)
- 145.
- 146. Deleted Code CPT® CodeShort Description Suggested Replacement(s) 99318 ANNUAL NURSING FAC ASSESSMNT 99307, 99308, 99309, 99310
- 147. Revised Nursing FacilityVisits CPT® Code Revised Description 99304 Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded. 99305 Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded. 99306 Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
- 148. Revised Nursing FacilityVisits CPT® Code Revised Description 99307 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. 99308 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. 99309 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. 99310 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
- 149. Revised Nursing FacilityVisits CPT® Code Revised Description 99315 Nursing facility discharge day management; 30 minutes or less total time on the date of the encounter 99316 Nursing facility discharge day management; more than 30 minutes total time on the date of the encounter Check guidelines to assist in determining time spent. The discharge services do not need to be completed on the day the patient leaves the facility.
- 150. Home or Residence Services Removalof Domiciliary or Rest Home Codes
- 151. Deleted Codes CPT® CodesShort Description Suggested Replacement(s) 99324 DOMICIL/R-HOME VISIT NEW PAT 99341, 99342, 99344, 99345 99325 DOMICIL/R-HOME VISIT NEW PAT 99341, 99342, 99344, 99345 99326 DOMICIL/R-HOME VISIT NEW PAT 99341, 99342, 99344, 99345 99327 DOMICIL/R-HOME VISIT NEW PAT 99341, 99342, 99344, 99345 99328 DOMICIL/R-HOME VISIT NEW PAT 99341, 99342, 99344, 99345
- 152. Deleted Codes CPT® CodeShort Description Suggested Replacement(s) 99334 DOMICIL/R-HOME VISIT EST PAT 99347, 99348, 99349, 99350 99335 DOMICIL/R-HOME VISIT EST PAT 99347, 99348, 99349, 99350 99336 DOMICIL/R-HOME VISIT EST PAT 99347, 99348, 99349, 99350 99337 DOMICIL/R-HOME VISIT EST PAT 99347, 99348, 99349, 99350
- 153. Deleted Codes CPT® CodeShort Description Suggested Replacement(s) 99339 DOMICIL/R-HOME CARE SUPERVIS 99242, 99491 99340 DOMICIL/R-HOME CARE SUPERVIS 99242, 99491 99343 HOME VISIT NEW PATIENT 99341, 99342, 99344, 99355 Home care supervision may be reported with the chronic care management or principal care management codes.
- 154. Revised Codes CPT® CodeDescription 99341 Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. 99342 Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. 99344 Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. 99345 Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.
- 155. Revised Codes CPT® CodeDescription 99347 Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. 99348 Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. 99349 Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. 99350 Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
- 156. Prolonged Services Healthcare CommonProcedure Coding System (HCPCS) Codes
- 157. Deleted Codes CPT® Codes Short DescriptionSuggested Replacement(s) 99354 PROLNG SVC O/P 1ST HOUR 99417 99355 PROLNG SVC O/P EA ADDL 30 99417 99356 PROLNG SVC I/P/OBS 1ST HOUR 99418 99357 PROLNG SVC I/P/OBS EA ADDL 99418
- 158. Revised Code 99417 •2023 •Prolongedoutpatient evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (List separately in addition to the code of the outpatient Evaluation and Management services) •2022 •Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each 15 minutes of total time (List separately in addition to codes 99205, 99215 for office or other outpatient Evaluation and Management services)
- 159. New Code 99418 Prolongedinpatient or observation evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (List separately in addition to the code of the inpatient and observation Evaluation and Management service)
- 160. CMS Coding –GXXX1 • G0316 Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (List separately in addition to CPT codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). (Do not report G0316 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418). (Do not report G0316 for any time unit less than 15 minutes)
- 161. CMS Coding –GXXX2 • G0317 (Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (List separately in addition to CPT codes 99306, 99310 for nursing facility evaluation and management services). (Do not report G0317 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418). (Do not report G0317 for any time unit less than 15 minutes)
- 162. CMS Coding –GXXX3 • G0318 (Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (List separately in addition to CPT codes 99345, 99350 for home or residence evaluation and management services). (Do not report G0318 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99417). (Do not report G0318 for any time unit less than 15 minutes)
- 163. Initial Hospital Inpatientor Observation Care CPT® Time (In minutes) Must meet or exceeded 99221 40 99222 55 99223 75 99418 90 minutes or longer G0316 105 minutes or longer
- 164. Subsequent Hospital Inpatientor Observation Care CPT® Time (in minutes) Must meet or exceeded 99231 25 99232 35 99233 50 99418 65 minutes or longer G0316 80 minutes or longer
- 165. Admit/Discharge Same Day CPT®Code Time (in minutes) Must meet or exceed 99234 45 99235 70 99236 85 99418 100 minutes or longer G0316 125 minutes or longer
- 166. Office/Other Outpatient Consultations CPT®Code Time (in minutes) Must meet or exceed 99242 20 99243 30 99244 40 99245 55 99417 70 minutes or longer No Code CMS doesn’t cover
- 167. Inpatient or ObservationConsultations CPT® Code Time (in minutes) Must meet or exceed 99252 35 99253 45 99254 60 99255 80 99418 95 minutes or longer No Code CMS doesn’t cover
- 168. CMS Time Thresholdsto Report Other E/M Prolonged Services Primary E/M Prolonged Code Time Threshold Initial IP/OBS (99223) G0316 105 minutes Subsequent IP/OBS (99233) G0316 80 minutes Admit/Discharge Same Day (99236) G0316 125 minutes Initial NF Visit (99306) G0317 95 minutes
- 169. CMS Time Thresholdsto Report Other E/M Prolonged Services Primary E/M Prolonged Code Time Threshold Subsequent NF Visit (99310) G0317 85 minutes Home/Residence Visit New Pt (99345) G0318 141 minutes Home/Residence Visit Est Pt (99350) G0318 112 minutes
- 170. Revised Codes Other E/MServices
- 171. Revisions • 99446-99451 adding“or other qualified health care professional” to description • 99483 assessment & care planning for a patient with cognitive impairment updating to 60 minutes of total time on the date of the encounter • 99495-99496 transitional care management services cosmetic change to language • Medical decision making of at least moderate…. • At least moderate level of medical decision making….
- 172.
- 173. Deleted Codes –Use 64999 CPT® Code Description 0312T Vagus nerve blocking therapy (morbid obesity); laparoscopic implantation of neurostimulator electrode array, anterior and posterior vagal trunks adjacent to esophagogastric junction (EGJ), with implantation of pulse generator, includes programming 0313T Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator 0314T Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator 0315T Vagus nerve blocking therapy (morbid obesity); removal of pulse generator 0316T Vagus nerve blocking therapy (morbid obesity); replacement of pulse generator 0317T Vagus nerve blocking therapy (morbid obesity); neurostimulator pulse generator electronic analysis, includes reprogramming when performed
- 174. Deleted Codes CPT® CodeDescription 0470T Optical coherence tomography (OCT) for microstructural and morphological imaging of skin, image acquisition, interpretation, and report; first lesion 0471T Optical coherence tomography (OCT) for microstructural and morphological imaging of skin, image acquisition, interpretation, and report; each additional lesion (List separately in addition to code for primary procedure) OCT for microstructural and morphological imaging of skin, use CPT® code 96999
- 175. Deleted Codes –Use 93799 CPT® Code Description 0475T Recording of fetal magnetic cardiac signal using at least 3 channels; patient recording and storage, data scanning with signal extraction, technical analysis and result, as well as supervision, review, and interpretation of report by a physician or other qualified health care professional 0476T Recording of fetal magnetic cardiac signal using at least 3 channels; patient recording, data scanning, with raw electronic signal transfer of data and storage 0477T Recording of fetal magnetic cardiac signal using at least 3 channels; signal extraction, technical analysis, and result 0478T Recording of fetal magnetic cardiac signal using at least 3 channels; review, interpretation, report by physician or other qualified health care professional
- 176. Deleted Codes CPT® CodeDescription 0487T Biomechanical mapping, transvaginal, with report 0491T Ablative laser treatment, non-contact, full field and fractional ablation, open wound, per day, total treatment surface area; first 20 sq cm or less 0492T Ablative laser treatment, non-contact, full field and fractional ablation, open wound, per day, total treatment surface area; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) 0493T Contact near-infrared spectroscopy studies of lower extremity wounds (eg, for oxyhemoglobin measurement)
- 177. Deleted Codes –Use 93799 CPT® Code Description 0497T External patient-activated, physician- or other qualified health care professional- prescribed, electrocardiographic rhythm derived event recorder without 24-hour attended monitoring; in-office connection 0498T External patient-activated, physician- or other qualified health care professional- prescribed, electrocardiographic rhythm derived event recorder without 24-hour attended monitoring; review and interpretation by a physician or other qualified health care professional per 30 days with at least one patient-generated triggered event
- 178. Deleted Codes CPT® CodeDescription 0514T Intraoperative visual axis identification using patient fixation (List separately in addition to code for primary procedure) 0702T Remote therapeutic monitoring of a standardized online digital cognitive behavioral therapy program ordered by a physician or other qualified health care professional; supply and technical support, per 30 days 0703T Remote therapeutic monitoring of a standardized online digital cognitive behavioral therapy program ordered by a physician or other qualified health care professional; management services by physician or other qualified health care professional, per calendar month
- 179. References CPT Errata &Technical Corrections: https://www.ama-assn.org/practice-management/cpt/cpt-errata- technical-corrections E/M Microsite: https://www.ama-assn.org/practice-management/cpt/cpt- evaluation-and-management
Editor's Notes
- #6 I don’t have a slide on it, but CPT® code 0499T was originally to be deactivated but the AMA rescinded the change. A link to the CPT Errata & Technical Corrections is in the References section.
- #8 Added & deleted totals Do not include codes added, deleted, or revised in CY 2021 or CY 2022 with changes published in the CY 2023 book for the first time. The AMA totals include all the code changes between the 2022 book & 2023 book. Revised totals Do not include codes with changes to short and/or medium descriptions only and does not include changes to spacing and/or non-essential punctuation
- #12 15850-15854 is related to hernia repairs, which used to have 90-day global. Codes created to capture the cost of the suture removal kits.
- #13 The difference between 15853 and 15854 is that 15853 is the removal of sutures OR staples, and 15854 is sutures AND staples.
- #16 Here you can see where code 22857 was made a parent code so that code 22860 could be reported as the add-on code. Code 27280 is a re-arrangement of the “open” and “includes” instead of “including”.
- #17 Code 22860 has been added to report total disc arthroplasty of a second interspace performed via anterior approach. 22857 is the parent code, which was on the previous slide. Code 22860 is intended to be reported for the second interspace in conjunction with code 22857. If more than two interspaces are treated, then unlisted code 22899 is reported for the entire procedure.
- #21 Purpose of technology: • To increase accuracy of measuring and recording joint motion of the axial and appendicular skeleton • To record muscle function in standardized fashion • To decrease variability and bias of recording Code 0778T represents the measurement and recording of dynamic joint motion and muscle function that includes the incorporation of multiple inertial measurement unit (IMU) with concurrent surface mechanomyography ( sMMG ) sensors. The IMU sensors contain an accelerometer that measures acceleration and velocity of the body during movement, a gyroscope that measures the positioning, rotation, and orientation of the body during movement, and a magnetometer that measures the strength and direction of the magnetic field to orient the body position during movement relative to the earth’s magnetic north field. The sMMG sensors measure muscle function by quantifying muscle activation and contraction amplitude and duration by recording high sensitivity volumetric change. A combination of the sensors is used to dynamically record multi joint motion and muscle function bilaterally and concurrently during functional movement. Data collected from the wireless
- #23 Radiofrequency wand is inserted into the nose Wand is pressed against the nasal mucosa to create a lesion The lesion holds the nasal wall more open Commonly performed with other ablative procedures, such as inferior turbinate ablation
- #25 Simple description change. Removing Dacron & replacing with polyester.
- #26 Two new codes for Percutaneous arteriovenous fistula creation (36836, 36837). Other codes are for open approach. For lower extremities, use unlisted codes.
- #28 Last year, the cardiac cath codes came out with the concept of normal connections versus abnormal connections. Addition of five Category I codes (33900 33904) for reporting percutaneous pulmonary artery revascularization procedures by stent placement
- #29 • Pulmonary arterial stent procedures differentiated based on: • Underlying cardiac anatomy: “normal” connections vs “abnormal connections” • Laterality of the procedure: unilateral vs bilateral pulmonary artery stenting
- #33 AQMBF is an emerging technology that uses different processes, software, imaging cameras, and workflow.
- #34 May be used to treat conditions such as: • chronic deep vein insufficiency and • reflux in the deep venous system, or leg ulcers.
- #35 Cardiac radioablation is a new noninvasive treatment that uses functional radioablation in combination with mapping and targeting of the abnormal myocardium. It is used to treat arrhythmias, such as ventricular tachycardia.
- #40 0781T-0782T thermoplasty applied to inside the bronchial tree for asthmatics. New technology for patients with COPD. Overactivity of pulmonary nerves that restrict & if nerves are destroyed, allows for better breathing. (Double check) Technology is similar. This one treats pulmonary nerves outside of the lungs. Once per treatment session, not how many times you zap the patient
- #41 Myoelectrical Measurement non-invasive – records myoelectrical activity from stomach through colon. Like an EKG but for checking the GI tract/GI motility. Prolonged ilius, GI pain, other motility problems.
- #42 There are a ton of changes – and the new codes do not have global days assigned.
- #43 There are 16 new codes, if you include 15778 and 18 deleted codes
- #45 Doesn’t matter if open, laparoscopic or robotic
- #57 Extraction, antegrade Notice this one says “simple” and provides examples of what is considered simple
- #58 Notice that this one has the term complex, then examples of what is considered complex. Not an exhaustive list.
- #65 Important guideline changes for the facet joint injections. Imaging guidance is required to report the 6649x codes. If no imaging is used, then the 20552-20553 trigger point injection code should be used. If ultrasound guidance, then there are some category III codes to report. Another important clarification is that the number counted is the facet joints injected and not the number of nerves. Even if two nerves are injected within the same facet joint, only one unit of service is counted. The AMA did add some guidance on the use of modifier 50, but I didn’t repeat it here because guidance on the use of modifier 50 is payer-specific.
- #66 Although these are Category III codes, the AMA placed them within the Pain Management Section, with other codes in the 644xx series, so I thought I’d add them here.
- #68 Although these are Category III codes, the AMA placed them within the Pain Management Section, with other codes in the 644xx series, so I thought I’d add them here.
- #69 is performed to treat chronic nerve pain Lots of excludes codes to differentiate from other codes. Different from scrambler treatment. The injured nerve is localized using magnetic stimulation at the time of the initial treatment, the skin is marked (with photographic record) to facilitate rapid localization of the correct site for subsequent treatments, and the appropriate amplitude of magnetic stimulation is defined. Noninvasive electroneurography (nerve conduction) may be used as guidance to confirm the precise localization of the injured nerve, and when performed, should not be separately reported as a diagnostic study. A separate diagnostic nerve conduction study performed prior to the decision to treat with transcutaneous magnetic stimulation may be separately reported. Be sure to follow the parenthetical notes.
- #79 The term imaging in the last portion of the code description is updating to acquisition. The intent and use remains the same.
- #83 to assess bone strength, fracture risk, and bone mineral density. Code 0750T is reported if an appropriate digital X ray is not available, and a single digital X ray view of the hand is taken specifically to be used for DXR BMD analysis.
- #85 81445, 81450, 81455 were confusing, so worked on these to delineate DNA or DNA/RNA. DNA and RNA done at the same time, 81445. If RNA run later, then can report 81449. be consistent.
- #86 This update is also moving the DNA/RNA phrase to the end and alphabetizing the acronymns.
- #87 For this code, there is a little bit of rearrangement of the description, and some alphabetizing of the acronymns for some of the tests. The term “isoform expression or mRNA expression levels” is new.
- #88 81418 new for drug metabolism that includes specific genes. Must do at least 6 genes. Under, then use Category 1 codes 81441 inherited bone marrow failure syndromes patients with this are at higher risk of myeloplastic dysplasia, many other cancers
- #90 Heb B 87467 quantitative versus qualitative is 87340. For monitoring Hep B antigen negative & monitoring therapies. DNA is usually too low for monitoring.
- #96 major advancements in the laboratory section. Distinct from what happens through the microscope. Takes slide & allows a remote pathologist to review. Look for expansion to AI algorithms. This is not for archiving specimens. Must be involved in the diagnostic process.
- #104 For code 92229, the word automated is being removed and replaced with the term autonomous. The machine is automatically interpreting the data, so this aligns with the AMA’s definitions for the different AI types. Code 92284 Dark Adaptation Eye Exam – macular degeneration, should be termed diagnostic rather than screening for code 92284. Use for various retinal dystrophies. 95919 Quantitative pupillometry provides a noninvasive and objective assessment within the neurological examination. This review details the physiology of the pupillary light response, the clinical significance of changes in pupillary reactivity (may have differently sized pupils)
- #106 Prior to 2023, the CPT® code set did not provide a mechanism to differentiate between angiography of the pulmonary arteries and pulmonary veins when performed during cardiac catheterization procedures. NOR to report Prior to 2023, the CPT code set did not include a specific CPT code to report angiography of major aortopulmonary collateral arteries (MAPCAs) when performed during cardiac catheterization procedures. Includes selective introduction and positioning of the angiographic catheter, and the injection and RS&I
- #107 Introductory language for code 93574 clarifies that a distinct named pulmonary vein must be selectively cannulated and selective venous angiography of that vein performed for each instance that 93574 is reported. • Introductory language for code 93575 clarifies that a distinct MAPCA must be selectively cannulated and selective venous angiography of that MAPCA performed for each instance code 93575 is reported.
- #109 to teach the parent(s)/guardian(s)/caregiver(s) interventions that they can independently use to effectively manage the identified patient's illness(es) or disease(s). This service involves behavioral treatment training provided to a multiple family group of parent(s)/guardian(s)/caregiver(s), without the patient present. These services emphasize active engagement and involvement of the parent(s)/guardian(s)/caregiver(s) in the treatment of a patient with a mental or physical health diagnosis. These services do not represent preventive medicine counseling and risk factor reduction interventions. parent(s)/guardian(s)/caregiver(s) in group sessions, to use skills and strategies to address behaviors impacting the patient's mental or physical health diagnosis. These skills and strategies help to support compliance with the identified patient's treatment and the clinical plan of care. Watch the parenthetical notes. Not to be used for educational services like prenatal, obesity or diabetic instructions 96202, 96203 for MD/NPP in multiple families in a group setting for individual patient. Do not represent preventive medicine counseling/risk factor reduction. Teaching parents how to manage ADHD or disruptive children, dementia patients. Should run concurrently with another group for the patient to enhance the outcomes of what the patient is learning.
- #115 Neurorehabilitative therapy utilizing measurements based on body-motion captured through optical markerless technology Post-stroke rehab can be done in the home.
- #117 assists Type 2 diabetes patients with the titration of their medication. Not reportable with CGM codes
- #121 Proprioceptive - relating to stimuli that are produced and perceived within an organism, especially those connected with the position and movement of the body.
- #125 Be sure to review the guidelines for these services
- #126 This slide provides an overview of some of the changes. We will go into more detail on these in further slides. The hospital observation codes are being deleted and combined with the hospital inpatient and observation care services. This can cause a problem because “observation” is a patient status and the patient is still considered a hospital outpatient. The consultation codes will see the low level codes deleted, as the E/M codes will be aligned with the office visit E/M codes with the straightforward, low, moderate and high medical decision making guidance.
- #128 I want to draw your attention to code 99418. When the AMA initially published the E/M updates on their website, this code was placeholder code 993X0. The 2023 codes have been published, and code 99418 is the permanent code for this service.
- #129 While the outpatient office visits have been operating under the guidelines where an exam is not a required element of code selection, the 2023 updates expand the concept to the rest of the E/M codes that used the History/Exam/MDM components. Only minimal updates were made to the MDM table – for the Low & High levels of MDM. Be sure to read the specific guidelines to check for any definition changes for subsets of codes. Now, let’s dig into the details of the code updates.
- #135 Hospital discharge day management is being slightly revised to accommodate the addition
- #137 The lowest level of the consultation codes are being deleted to align the consultation codes with the others and keeping the four MDM levels of straightforward, low, medium and high. There is no change to the 3 R’s for a consultation: A request from a provider, the rendering of the consultation and a report being sent back to the requesting provider.
- #138 Some categories may apply to both new or established patients, such as hospital inpatient or observation care. In these circumstances, code selection is based on whether the care is the initial service or a subsequent service
- #139 The first two bullet points are the same as new/established patient. There is clarifying information regarding what is considered to be part of a single stay
- #143 Code 99281 was updated to align with CPT 99211. Requires supervision by clinical staff. Examples provided in training sessions with the AMA include removal of staples or stitches, TB skin test results. Did not mention LWBS. In ED, MD/NPP is juggling several patients at the same time. Sit & review multiple x-rays or scans at the same time. Sit & document in multiple medical records at one sitting.
- #145 This isn’t about changing the physician’s behaviors – this is more about changing their thinking on what needs to be documented. The doctors are already performing these things, but not always documenting.
- #147 The SNF visits and NF visits had the same amount of work. So this update streamlines the codes to be reported.
- #148 The revised nursing facility visit codes are similar to the inpatient/observation services in that there is the initial and subsequent codes to use. Also, check the guidelines because there are some additional definitions that may be used in the MDM table
- #152 Again, for these services, the AMA said that the work that’s involved didn’t vary, so they consolidated the codes.
- #161 In the final rule, the descriptor for this code still had the CPT place holder of 993X0, and I’ve updated it in these slides. Also, I’ve highlighted pertinent portions so you can see what the code is for.
- #162 In the final rule, the descriptor for this code still had the CPT place holder of 993X0, and I’ve updated it here.
- #164 CPT goes on 15-minute increments for these E/M codes. So code 99221 would cover minutes 40 to 54, code 99222 covers 55 minutes to 74 minutes, and 99223 covers minutes 75 to 89. Prolonged services begins with minute 90. We will come back to this in a few slides.
- #172 99446 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a verbal and written report to the patient's treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review
- #177 0487T – 58999 0491T-0492T – 17999 0439T – 93998
- #179 0514T – no suggested replacement 0702T-0703T - 98978