By Tina Bruce, MSHIM, MSHI, RHIA, CCS, CDIP
On September 7, 2021, the American Medical Association (AMA) released the CPT® code set changes for 2022. The AMA made 405 changes, which include 249 new codes, 63 deletions, and 93 code revisions that will become effective January 1, 2022. The 2022 CPT code updates include a series of immunization codes to proficiently describe and monitor vaccinations and administrative services.
The Anesthesia section of the CPT has seven new codes, 12 procedure code deletions, and 14 procedure codes were revised. For example, new for 2022 are: 01937 Anesthesia for percutaneous image-guided injection, drainage or aspiration procedures on the spine or spinal cord; cervical or thoracic, 01938 for lumbar or sacral; 01939 Anesthesia for percutaneous image-guided destruction procedures by neurolytic agent on the spine or spinal cord; cervical or thoracic, and 01940 lumbar or sacral. The new codes replaced 01935 and 01936 in this section. These codes were more general (differentiated diagnostic versus therapeutic) but did not specify the procedure performed nor the level of the spine or spinal cord involved. It is important to review the notes within this section of the CPT to ensure the appropriate coding guidelines are applied when coding and billing these procedures on a patient encounter.
Important Cardiology Code Changes
Industry professionals will be able to see some changes in the CPT cardiovascular procedure codes in the Medicine section. Coding professionals will see new codes for congenital heart defect cardiac catheterizations in the Medicine/Cardiovascular Procedure code section. These new congenital heart defect cardiac catheterization procedures are included in CPT procedure code range 93593-93598 and replace codes 93530-93533. Another new code is 93319 for 3D echocardiography imaging and postprocessing during a transesophageal echocardiography (TCC), or during transthoracic echocardiography for congenital cardiac anomalies, for the assessment of cardiac structure(s) and function, when performed. This TEE code is an add-on code to be used with 93303, 93304, 93312, 93314, 93315, and 93317, but it cannot be used in conjunction with 76376, 76377, 93325, or 93355.
CY 2022 COVID-19 and Other Immunization Updates
Several new codes have been added to capture intramuscular injections of SARS-CoV-2 (severe acute respiratory syndrome coronavirus) as well as the vaccine itself. The new vaccine product codes are 91300 through 91304; first dose injection procedure codes – 0001A, 0011A, 0021A, 0041A; second dose injection procedure codes 0002A, 0012A, 0022A, and 0042A; and single dose injection procedure code – 0031A. The Centers for Medicare and Medicaid Services (CMS) has provided some HCPCS II M codes for other COVID-19-related vaccines. Refer to the 2022 HCPCS file on the CMS website (cms.gov). The AMA website (https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-vaccine-and-immunization-codes and https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-coding-and-guidance) is also a great resource for more information on COVID-19 related coding for tests and vaccines.
Guidelines for the immunization administration for vaccines/toxoids (listed in the CPT code book prior to 90460) have been revised for 90460 and 90461. They are reported for face-to-face counseling of the patient or family by a physician or other qualified healthcare professional, other than when performed for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccines. For immunization administration of any vaccine, other than SARS-CoV-2 (coronavirus disease [COVID-19]) vaccines, which is not accompanied by face-to-face physician or other qualified health care professional counseling to the patient/family/guardian or for administration of vaccines to patients over 18 years of age, report codes 90471-90474.
Additional coding guidelines have been added for the administration of COVID-19 vaccinations. These guidelines stipulate that codes 0001A, 0002A, 0011A, 0012A, 0021A, 0022A, 0031A, 0041A, and 0042A should be used for the immunization administration of SARS-CoV-2 (coronavirus disease [COVID-19]) vaccines only. Each administration code is specific to each individual vaccine product (e.g., 91300, 91301, 91302, 91303, 91304), the dosage schedule (e.g., first dose, second dose), and counseling, when performed. The appropriate administration code is chosen based on the type of vaccine and the specific dose number the patient receives in the schedule. One example provided in the Medicine section guidelines notes that code 0012A is reported for the second dose of vaccine 91301. Do not report 90460-90474 for the administration of SARS-CoV-2 (coronavirus disease [COVID-19]) vaccines. Codes related to SARS-CoV-2 (coronavirus disease [COVID-19]) vaccine administration are listed in Appendix Q.
Evaluation and Management Section
In CY 2022, new principal care management codes will be available in this CPT section. These new procedure codes enable providers the ability to capture chronic care management services. The reporting of these chronic care management services will provide a better understanding of the statistical criteria surrounding chronic care monitoring and treatment of complex medical problems for certain patient populations. In addition, telemedicine and digital medicine has evolved over the last couple of years. The heightened need for more remote physician visits over the phone or via teleconferences has increased the need for new principal care management codes. Two new CPT subsections were added titled “Remote Therapeutic Monitoring Services” that includes codes 98975 through 98977 and the “Remote Therapeutic Monitoring Treatment Management Services” subsection that includes codes 98980 and 98981. These new procedure codes will improve the coding and reporting of telemedicine services provided to a given number of patients who choose to continue meeting with their providers electronically to manage their care digitally instead of seeing the provider face to face. Evaluation and management time coding guidelines were revised to include specific instructions and guidance, which states that time should not be counted when spent on:
- the performance of other services that are reported separately;
- travel; and
- teaching that is general and not limited to discussion that is required for management of a specific patient.
Under the section “Number and Complexity of Problems Addressed at the Encounter,” the subheading of “Surgery” has been added to provide surgical definitions for minor, major, elective, and emergency surgery. These revisions include definitions for risk factors.
Pathology and Laboratory Section
An extensive number (91) of the new procedure codes are found within the CPT Pathology and Laboratory section. CPT code 80220 will be used to capture drug assays for hydroxychloroquine on or after January 1, 2022. Many insurance companies have their own coverage policies for these new codes, so understanding payment policies and when they are covered and not covered is important to the overall revenue cycle and healthcare organization reimbursement of these tests. Pathology and clinical laboratory findings are often performed during patient care. Much of the non-face-to-face time and activities, such as review of pathology and laboratory test results, occurs in conjunction with the provision of an evaluation and management (E/M) service. Considered part of the non-face-to-face time activities related with the overall E/M service, reviewing pathology and laboratory results is not a separately reportable service. The coding guidelines for pathology and laboratory have been revised to include coding guidance for pathology consultation codes (80503, 80504, 80505, and 80506). The guidelines indicate these codes describe the physician pathology clinical consultation services provided at the request of another physician at the same or another hospital or institution. Be sure to review the guidelines for these codes in the 2022 CPT code book.
New updated definitions are found for fracture procedures at the beginning of the section such as manipulation, traction, and percutaneous skeletal fixation. Manipulation now states that if satisfactory alignment (reduction) is not maintained and the same provider is performing the second manipulation that a -76 modifier should be used. Closed treatment has been revised to indicate that splinting, strapping, or casting is used only to stabilize a fracture temporarily for the patient’s comfort, is not considered closed treatment.
Codes 21315 and 21320 were revised to now include “with manipulation” as well as with or without stabilization. If there is no manipulation or stabilization of a nasal bone fracture, then the appropriate E/M code is assigned. Code 21310 (closed treatment of nasal bone fracture without manipulation) was deleted for 2022. (Refer to the note after 21315.)
We are always waiting for the upcoming changes and wondering what will change for the upcoming year. You can see that many of the changes can be found within the Pathology and Laboratory sections. It is important to always take time and review any changes to each section’s specific CPT guidelines and notes that are included for coding guidance. These notes are imperative to ensuring the appropriate code selection and healthcare reimbursement is received by healthcare organizations and providers.
Tina Bruce is a coding educator with Ensemble Health Partners.Leave a comment