The New Year’s Impact on CPT Codes

Right when healthcare professionals have adjusted to the 2021 E/M guideline frenzy, now it’s time to learn the new 2022 CPT codes.

What changes are impacting CPT Codes?

Starting January 1, 2022, there will be 405 total changes, including 249 new codes, 63 deletions and 93 revisions.

CPT Codes within the E/M Section

The majority of revisions in the E/M section revolve around technology and care management. According to the American Medical Association (AMA), five new codes (98975, 98976, 98977, 98980 and 98981) will be available to report therapeutic remote monitoring, reflecting the increase in digital care services amid the pandemic. These codes will expand on the remote physiologic monitoring codes created in 2020, including 99453, 99454, 99457 and 99458.

Technology innovations continue to enforce CPT code changes, the AMA noted, with 43% of the latest changes associated with Category III codes (which are for emerging technologies, services and procedures) or the Proprietary Laboratory Analyses (PLA) section. This is on track with 2021, when these two CPT code sets saw growth in the new and novel areas of medicine by 63%.

Principal Care Management
Principal Care Management (PCM), which was established by the Medicare program and took effect in 2020, saw a significant change. State providers can now assign these codes for patients with a single chronic condition, whereas previously such services were reimbursed only for patients with multiple chronic conditions. The new codes (99424, 99425, 99426 and 99427) plus the revisions to existing codes aim to better align with Medicare guidelines.

Technical Corrections
Technical corrections were made for the Office Visit E/M codes. For example, previous guidance stated if a test can be reported under an existing CPT code and is reported by any physician or QHP of the same specialty/group, it is not reportable as Data under the MDM. However, new guidance states that if a test does not require a separate interpretation (i.e., results only test) AND is analyzed as part of the MDM, this would count as one item towards ordered/reviewed in Data.

CPT is also recognizing how the Social Determinants of Health (SDOH) impact the E/M level of service through time or MDM. The Table of Risk now includes ‘Diagnosis or treatment significantly impacted by SDOH’ under the Risk of Complications column of the table. In addition, care coordination addressing SDOH can be factored into the time associated with an office visit.

COVID Vaccinations

To help ensure accurate coding and reporting of COVID-19 vaccines and administration services, the AMA offers a vaccine code finder resource to help identify the appropriate CPT code combination for the type and dose of COVID-19 vaccine provided to each patient.

The new Category I CPT codes and long descriptors for the vaccine products are:

• 91300 - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine, mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use. 
• 91301 for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 100 mcg/0.5mL dosage, for intramuscular use.

In accordance with the new vaccine-specific product CPT codes, the CPT editorial panel worked with the Centers for Medicare & Medicaid Services (CMS) to create new vaccine administration codes that are both distinct to each coronavirus vaccine and the specific dose in the required schedule.

This level of specificity is a first for vaccine CPT codes, but offers the ability to track each vaccine dose, even when the vaccine product is not reported, such as when the vaccine may be given to the patient for free, the AMA stated.

These CPT codes report the actual work of administering the vaccine in addition to all necessary counseling provided to patients or caregivers and updating the electronic record. The AMA has published resources (PDF) about the new vaccine administration CPT codes and long descriptors.

2022 CPT Code Changes

The following are other changes to CPT codes for 2022.

Cardiovascular
The Cardiovascular Surgery section saw changes with three new codes for exclusion of left atrial appendage. Introductory guidelines and parentheticals were also added. The new codes cannot be reported with Maze procedures (33254-33259, 33265, 33266) or mitral valve repair/replacement procedures (33420, 33422, 33425-33427, 33430).

The additions are as follows:

• Code 33267 is for exclusion of left atrial appendage when performed by an open approach.
• Code +33268 is an add-on code for exclusion of the left atrial appendage when performed by an open approach at the time of another sternotomy or thoracotomy procedure.
• Code 33269 is for exclusion of the left atrial appendage when performed by a thoracoscopic approach

CPT code 33509 was created to report endoscopic harvest of an upper extremity (UE) artery, as opposed to vein, for coronary artery bypass procedures (CABG). Instructional guidance also states, should this be performed bilaterally, modifier -50 is assigned.

Audiology
The Audiology section saw changes within the osseointegrated implant procedures, with deletions of codes 69715 and 69718, revisions of codes 69714 and 69717 and new codes 69716, 69719, 69726 and 69727.

• Code 69716 describes the implantation of the osseointegrated implant.
• Code 69719 describes the replacement including removal of the implant.
• Code 69726 describes the removal of the osseointegrated implant with percutaneous attachment to an external speech processor.
• Code 69727 describes the removal of the osseointegrated implant with magnetic transcutaneous attachment to an external speech processor.

Medicine
Several changes were made regarding EPS cardiac ablation and congenital heart defect coding.

• Code 93593 describes a right heart catheterization on a patient with normal native connections.
• Code 93594 describes a right heart catheterization on a patient with abnormal native connections.
• Code 93595 describes a left heart catheterization on a patient with normal or abnormal native connections.
• Code 93596 describes a left and right heart catheterization on a patient with normal native connections.
• Code 93597 describes a left and right heart catheterization on a patient with abnormal native connections.
• Add-on code +93598 describes cardiac output measures.

Codes 93530-93533 are deleted in CPT2022. Several tables with guidance, definition updates and illustrations were added to this section.

Nervous System
As with the Medicine section, the Nervous System also has several newly added illustrations and definitions. Creating codes for laminectomies provided in conjunction with arthrodesis are the main updates in the Nervous System section.

Two new add-on codes, +63052 and +63053, report laminectomy, facetectomy, or foraminotomy during a posterior interbody arthrodesis (Codes located in the 22XXX series). These add-on codes can be reported with 22630, 22632, 22633, and 22634. You’ll notice in the code descriptor that only “lumbar” is included because this procedure is only performed on the lumbar spine.

Musculoskeletal System The main changes in this system appear in the introductory guidelines with revisions that include “the application and removal of the first cast, splint, or traction device, when performed.” Report subsequent cast or strapping codes when performed after the global period.

Fracture and dislocation guidelines are revised to indicate that the codes are structured to be selected based on the type of treatment and type of stabilization, not the type of fracture. There are instances when a closed fracture will require open treatment.

The code for closed treatment of nasal bone fracture without manipulation (21310) is deleted. Closed treatment of nasal bone fracture codes 21315 and 21320 are revised to include “with manipulation.” Code 21315 is reported when manipulation is performed without stabilization. Code 21320 is reported when the procedure is performed with stabilization.

New guidelines and definitions are added to the posterior/posterolateral techniques for spine procedures in this code update. There has been confusion over the years regarding the terminology used in some of the spine codes and when certain procedures can be reported together. Codes 22600-22614 are revised to change “level” to “interspace.” Definitions are added for corpectomy, facetectomy, foraminotomy, hemilaminectomy, laminectomy, and laminotomy. Codes 22633 and 22634 are revised to remove “and segment.”

Other CPT Code Updates

• Radiology: a new code structure has been developed for trabecular bone scan reporting. There are now four codes to describe the entire service, the technical component only and the interpretation and report: CPT 77098, 77090, 77091 and 77092.
• Interventional Cardiology: changes in this section include the deletion of current right and left heart catheterization codes with the creation of new codes.
• Anesthesia and Pain Management: the current codes for image-guided spinal procedures have been deleted and replaced. 01935-01936 have been replaced with 01937 and 01938.
• Urology: the category III codes for paraurethral balloon continence device procedures have been converted to category I codes; 53451, 53452, 53453 and 53454. These codes include the cystourethroscopy and imaging guidance.
• Ophthalmology: Cataract removal with drainage device insertion were reported with two category III codes but for 2022 these codes have been re-structured to now be reported with two category I codes (66989 and 66991) and one category III code (0671T).

The Impact of CPT Code Changes on Your Healthcare Organization

The 2022 CPT code changes include several description additions and updates that should be incorporated into your healthcare organization. For an entire listing of all additions, deletions, and revisions, visit the 2022 CPT Code Book.

The AMA also publishes a 2022 CPT Code Changes book that specifically lists the detailed changes. Also, be on the lookout for any changes made after the book publication, in the form of an official “errata”, which will be posted to the AMA website.

We encourage practices and facilities to review these changes with providers, affected clinical departments, update fee schedules and chargemasters and include revenue cycle, coders and billers in the conversations.

Unsure how to get started or have a question related to the changes? Eide Bailly is available to assist in education and training for providers, clinicians and revenue cycle personnel as needs arise.

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