Debut of 2021 CPT codes includes 200-plus additions, dozens of revisions, deletions

by: DecisionHealth Editors Sep 8, 2020

Take a first look at the CPT codes you’ll report next year for a variety of services, including the prolonged service E/M code that you can tack onto time-based E/M office visits. All told, you’ll find more than 207 new codes, 48 revisions and 52 deletions, according to a 2021 CPT data file released Sept. 1.

While practices gained a preliminary glimpse of some code descriptors in the proposed 2021 Medicare physician fee schedule released in August, the new CPT file provides a complete list of new and revised codes for 2021 reporting as well as additional coding guidelines. The full CPT manual will be available at the end of the month.

In the proposed fee schedule, CMS used placeholder codes that can’t be used to report services. For instance, CMS used 99XXX for the new prolonged service E/M code, but now you’ve got the full, five-figure code – 99417, which you’ll use to report the time for a prolonged office visit.

However, note that the official 2021 code descriptor varies from the previous code description that the AMA released back in June 2019. The official description for 99417, effective Jan. 1, is:

Prolonged office or other outpatient evaluation and management service(s) beyond the ~~total time~~ 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) (strike outs and emphasis added)

Note: Check our previous coverage for more information on the historic update to E/M office visit codes 99202-99215.

Prepare for other key updates

Cardiovascular services increase. You’ll find five new codes in the cardiovascular system section of your 2021 CPT manual, including 33745 (Transcatheter intracardiac shunt (TIS) creation by stent placement for congenital cardiac anomalies to establish effective intracardiac flow, including all imaging guidance by the proceduralist, when performed, left and right heart diagnostic cardiac catherization for congenital cardiac anomalies, and target zone angioplasty, when performed (eg, atrial septum, Fontan fenestration, right ventricular outflow tract, Mustard/Senning/Warden baffles); initial intracardiac shunt) and add-on code 33746 (… ; each additional intracardiac shunt location [List separately in addition to code for primary procedure]).
Three new vestibular evoked myogenic potential (VEMP) testing codes will be included in the CPT 2021 update.
Breast reconstruction: 15 codes revised, two deleted. You’ll find that the word breast replaces mammary and that selecting a breast reconstruction code is easier next year thanks to revisions that detail what the procedure involves and when it was performed. For example, the descriptor for implant removal code 19330 (Removal of mammary implant material) will become Removal of ruptured breast implant, including implant contents (eg, saline, silicone gel). The descriptor for revision code 19380 (Revision of reconstructed breast) will expand into the more detailed “Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction).” You will know whether the post-mastectomy insertion of an implant was immediate, i.e., on the same day as the mastectomy, or delayed, i.e., on a subsequent day, based on the descriptors. For example, insertion code 19340 (Insertion of breast implant on same day of mastectomy [ie, immediate]). Finally, two codes have been deleted: 19324 (Mammaplasty, augmentation; without prosthetic implant). A note directs you to codes 15771 or 15772 for reconstruction with fat graft. Other reconstruction code 19366 (Breast reconstruction with other technique) has also been deleted.
Slight tweaks to nervous system codes. After last year’s massive revamp of nerve block codes, pain management specialists will be relieved to learn that the only changes involve the addition of an “s” and punctuation changes that will make plantar common digital injections (64455) and transforaminal epidural injections (64479-64484) into child codes of 64400 (Injection[s], anesthetic agent[s] and/or steroid; trigeminal nerve, each branch [ie, ophthalmic, maxillary, mandibular]). For example, the descriptor for 64455 change from Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton's neuroma) to Injection(s), anesthetic agent(s) and/or steroid; plantar common digital nerve(s) (eg, Morton's neuroma).
128 new laboratory codes. Additions to the pathology and laboratory chapter include 10 new codes for assay of therapeutic drugs, such as 80143 (Acetaminophen), and eight COVID-19 codes that range from 86328 (Immunoassay for infectious agent antibody[ies], qualitative or semiquantitative, single-step method [eg, reagent strip]; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease {COVID-19}) to proprietary lab code 0226U (Surrogate viral neutralization test [sVNT], severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease {COVID-19}], ELISA, plasma, serum).
Category III codes go unlisted or permanent. You’ll find the removal of 22 codes from the category III section of the manual. In some instances, you’ll report an unlisted code for the procedure. Transforaminal epidurals performed with ultrasound needle guidance (0228T-0231T) are one such example. However, procedures such as external electrocardiographic recording that lasts 48 hours or more will achieve permanent status next year (93241-93248). Take a close look at the new codes and descriptors because they don’t crosswalk directly. For example, the four category III codes describe a 48-hour to 21-day period. The eight new permanent codes have a 48-hour to 7-day or 7 to 15-day timeline.
Additional updates to the CPT manual will include 32408 (Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed) and two new nasopharyngoscopy codes: 69705 (Nasopharyngoscopy, surgical, with dilation of eustachian tube [ie, balloon dilation]; unilateral) and 69706 ( … ; bilateral).
Shoulder debridement demystified. In the musculoskeletal section, significant expansions to the descriptions of arthroscopic shoulder debridement codes should help practices distinguish at last between 29822 (Limited debridement) and 29823 (Extensive debridement). In essence, if the surgeon debrides one to two “discrete structures” in the shoulder, it’s limited. If they debride three or more, it would be coded as extensive. Bone and soft tissue qualify as discrete structures.
Lung cancer screening code added. Radiology section changes include the addition of a new code (71271) for CT lung cancer screening (existing thorax CT codes 71250-71270 were revised to specify “diagnostic”) and a new code (76145) for evaluating radiation dose exposure that exceeds “institutional review threshold,” among other changes.
New ultrasound treatment code for prostate cancer. Surgeons will have a new code (55880) to report for ablation of malignant prostate tissue using high-intensity, focused ultrasound (HIFU) via a transrectal approach.
New Ob-Gyn colposcopy mapping code. Surgeons will have a new add-on code (57465) to report for mapping of the cervix uteri during colposcopy procedures.

2021 CPT manual change counts by chapter

Chapter	New	Revised	Deleted
E/M (99201-99499)	2	17	1
Anesthesia (00100-01999)	0	0	0
Surgery:
Integumentary (10004-19499)	0	17	2
Musculoskeletal (20100-29999)	0	2	0
Respiratory (30000-32999)	2	0	1
Cardiovascular (33016-37799)	5	4	0
Hemic & Lymphatic (38100-38999)	0	0	0
Mediastinum & Diaphragm (39000-39599)	0	0	0
Digestive (40490-49999)	0	0	1
Urinary (50010-53899)	0	0	0
Male Genital System (54000-55899)	1	0	0
Female Genital System (56405-58999)	1	0	2
Maternity Care & Delivery (59000-59899)	0	0	0
Endocrine System (60000-60699)	0	0	0
Nervous System (61000-64999)	0	5	4
Eye & Ocular Adnexa (65091-68899)	0	0	0
Auditory System (69000-69979)	2	0	1
Radiology (70010-79999)	2	5	2
Pathology & Laboratory (80047-0138U)	131	9	8
Medicine (90281-99607)	18	4	9
Category II (0001F-9007F)	0	1	0
Category III (0042T-0639T)	45	1	22
Totals	207	48	52

Source: DecisionHealth analysis of AMA data

Blog Tags: AMA

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