Current Procedural Terminology (CPT®) – Page 2

UHC Network News July 1, 2024

Take Note: Quarterly CPT and HCPCS Code Updates

Effective Jul. 1, 2024, all applicable Medical Policies and Medical Benefit Drug Policies have been updated to reflect the quarterly Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) code additions, revisions, and deletions. Refer to the following sources for information on the code updates:

American Medical Association: Current Procedural Terminology: CPT®

Centers for Medicare & Medicaid Services: Healthcare Common Procedure Coding System (HCPCS) Quarterly Update

How to Use Add-on Code G2211

COVID-19 CPT vaccine and immunization codes

After the 2024 CPT book was printed, the AMA deleted 64 codes and Appendix Q.

COVID-19 Vaccines
Administration
• 90480 – Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, single dose
Vaccine Product
• 91318 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 3mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use (6
months to 4 years) Pfizer
• 91319 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)(coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 10mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use (5-11
years) Pfizer

• 91320 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 30 mcg/0.3 mL dosage, tris-sucrose formulation, forintramuscular use (12 years and older) Pfizer
• 91321 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 25 mcg/0.25mL dosage, for intramuscular use (6 months – 11 years) Moderna
• 91322 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 50 mcg/0.5 mL dosage, for intramuscular use (12 years and older) Moderna

Receive More Accurate Payment for Medicare Complex Visits.

The new code will take effect Jan. 1, 2024. The 2024 Medicare Physician Fee Schedule allows physicians to list G2211 in addition to codes used in-office or outpatient visits for new or established patients (i.e., 99202-99215). Physicians can also use it for telehealth visits.

Texas Medical Association continues to push for additional guidance as confusion over the code’s use persists.

Check Your Modifier 25 Knowledge

Our Friend Betsy Nicoletti founder of CodingIntel, says “It’s hard for me to think of a topic that invites so much disagreement between coders and auditors, between practices and payers and with our practitioners.”

She has put together a short little quiz on the topic (below). Tell us how you did.

Aetna Update August 2022

Effective 11/1/2022

Computer-assisted surgical and musculoskeletal navigation coding update.
Aetna® will no longer consider the following codes for separate reimbursement:
• 20985 (Computer-assisted surgical navigational procedure for musculoskeletal procedures, image-less (List separately in addition to code for primary procedure))
• 0054T (Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image-guidance based on fluoroscopic images (List separately in addition to code for primary procedure)). The use of computer-assisted surgical navigation is considered
integral to the performance of the procedure.

Sick of Chart Review Request?

If you are frequently being ask by Cigna MA for chart reviews, click the button below to find out how to reduce the number of requests you receive.

AMA unveils anticipated E/M changes for facility-based services

The AMA set off its own fireworks during the Independence Day weekend with the early release of new E/M guidelines that will be included in the 2023 CPT manual and take effect Jan. 1, 2023

Beginning on that date, the format for office and other outpatient visits (99202-99215) will apply to hospital inpatient and observation visits, consults, and services in the emergency department, nursing facility, home and residence. As a result, history and physical examination will no longer contribute to the level for these visits. Instead, for most visits practices will select codes based on medical decision-making (MDM) or time. The only exception will be emergency department visits, which will be MDM-only because the codes do not have a time component.

Among the most radical changes, the AMA plans to delete all observation care codes (99217-99220, 99224-99226) and merge observation services with initial and subsequent hospital care codes (99221-99223, 99231-99233, and 99238-99239)

The Most Asked Questions About Medical Coding Audits Following the 2021 E/M and MDM Changes ~MGMA

In the above linked article you will find:

What E/M Updates to Watch
The definition of “external” for purposes of reviewing data as part of MDM.
What is time-based coding?
Documentation Tips
And More

Tag: Current Procedural Terminology (CPT®)