Practices can expect nearly 400 code changes in their 2023 CPT manuals, including 224 new codes, 93 revised and 74 deleted codes.
Now that the rest of the 2023 updates are public, take note of numerous other changes scattered throughout the 2023 manual:
- E/M services. The single new code in the E/M section is for inpatient prolonged services. The new code, 99418, is an inpatient counterpart to the 99417 prolonged services code that debuted in 2021. Here’s the full descriptor for 99418, effective Jan. 1:
- 99418 (Prolonged inpatient 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])
To incorporate the full E/M update, you must look beyond the update to level-based E/M visits and prolonged services. You won’t need to wonder if nurse practitioners or physician assistants can report interprofessional consult codes 99446-99449 and 99451. The descriptors will be revised to include qualified health care professionals.
Revisions to the descriptor for assessment and care planning code 99483 increase the typical time from 50 minutes to 60 minutes and ease the face-to-face requirement. The language that states the service is performed “face-to-face with the patient and/or family or caregiver” has been changed to “on the date of the encounter.”
The descriptors for transitional care management codes contain slight tweaks to the bullet point for medical decision-making. Code 99495 will be revised from “medical decision making of at least moderate complexity during the service period” to “at least moderate level of medical decision making during the service period.” Code 99496 will be revised to state “high level of medical decision making during the service period.”
- Removal of sutures/staples codes revised and expanded. The AMA is deleting code 15850 (Removal of sutures under anesthesia [other than local] same surgeon) and revising code 15851 to clarify the definition of anesthesia and remove the same surgeon/other surgeon language. Note the new 15851 definition: “Removal of sutures or staples requiring anesthesia (ie, general anesthesia, moderate sedation).”
New add-on codes will allow practices to report suture or staple removal with an E/M visit in the office visit when anesthesia is not required. Report code 15853 for “removal of sutures or staples” and code 15854 for “removal of sutures and staples.” These codes are for practice expense only – no physician work value is included – and should not be separately reported during a 10- or 90-day global surgical period.
- Total disc arthroplasty code moves from Category III to Category 1 status. Code 0163T (Total disc arthroplasty [artificial disc], anterior approach, including discectomy to prepare interspace [other than for decompression], each additional interspace, lumbar) has been deleted for 2023. In its place, the AMA debuts a new add-on code, 22860, to report for anterior implant of a total disc arthroplasty at a second level only. For third and all other levels, report the unlisted code 22899. Initial total disc arthroplasty code 22857 is revised to be a parent code.
- Sacroiliac joint fusion code changes. After advising practices earlier this year that percutaneous sacroiliac (SI) arthrodesis code 27279 requires placement of fixation across the joint, the AMA is adding a new Category III code for SI joint fusions that are entirely intra-articular: 0775T (Arthrodesis, sacroiliac joint, percutaneous, with image guidance, includes placement of intra-articular implant[s] [eg, bone allograft(s), synthetic device(s)]. The AMA made grammatical revisions to open SI joint arthrodesis code 27280 with no change to its meaning, and made no changes at all to percutaneous SI joint fusion code 27279.
- Digestive system. Updates to this chapter include two new codes for the placement and removal of gastric balloons. However, the major revisions to hernia repair codes gave this chapter the greatest number of changes in the surgery section of the CPT manual. Hernia repair codes 49560-49590 and 49652-49657 are based on several factors including the type of hernia, the approach for the procedure and the age of the patient. They will be deleted and replaced with two major code families that describe hernia repair by any surgical approach and include the implantation of mesh or other prosthesis when performed. Whether the hernia is reducible or incarcerated/strangulated will remain a factor in code selection.
The anterior abdominal hernia code family contains subfamilies for initial hernias (49591-49596) and recurrent hernias (49613-49618). Each subfamily is subdivided by the size of the hernia – less than 3 cm, 3 to 10 cm, and 10 cm – and whether the defect is reducible or incarcerated/strangulated. Example: 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). Code 49591 describes an initial hernia of 3 cm or less that is incarcerated or strangulated.
The second family contains two codes for repair of parastomal hernias based on whether the hernia is reducible (49621) or incarcerated/strangulated (49622).
A new add-on code will describe the removal of mesh: 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].
- Nervous system. The next update will continue the trend of bundling image guidance into nerve block codes. Fluoroscopic and ultrasound needle guidance will be bundled into codes for brachial plexus blocks (64415-64416), axillary nerve blocks (64417), sciatic nerve blocks (64445-64446) and femoral nerve blocks (64447-64448).
- Radiology. Four single photon emission computed tomography (SPECT) codes (78803 and 78830-78832) will be revised “to differentiate reporting separate acquisitions with two radiopharmaceuticals,” according to CPT Editorial Summary of Panel Actions for the May 2022 meeting. For example the phrase “or acquisition” has been added to the descriptor for 78803 (Radiopharmaceutical 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). In addition, redundant mentions of pelvis will be removed from the descriptors for 78831 and 78832.
- Medicine. The AMA released codes for COVID-19 throughout the year, and they’ll appear in the CPT manual for the first time. Additions to the chapter include 27 new vaccine codes.
- Category III codes. You’ll find a variety of high-tech procedures in the 68 new Category III codes. Examples include codes to describe virtual reality to assist with therapy, transcutaneous magnetic stimulation to treat chronic pain and electrocardiograms paired with artificial intelligence.
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CY2023 CPT code changes by chapter
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Chapter
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Additions
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Revisions
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Deletions
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|
Evaluation and management
|
1
|
49
|
25
|
|
Integumentary system
|
3
|
1
|
1
|
|
Musculoskeletal system
|
1
|
2
|
0
|
|
Respiratory system
|
1
|
0
|
0
|
|
Cardiovascular system
|
7
|
1
|
0
|
|
Digestive system
|
17
|
0
|
18
|
|
Urinary system
|
1
|
1
|
0
|
|
Male genital system
|
1
|
0
|
0
|
|
Nervous system
|
0
|
7
|
0
|
|
Eye and ocular adnexa
|
0
|
2
|
0
|
|
Auditory system
|
3
|
5
|
0
|
|
Radiology
|
1
|
5
|
0
|
|
Pathology and laboratory
|
82
|
7
|
7
|
|
Medicine
|
38
|
9
|
0
|
|
Category III
|
68
|
3
|
23
|
|
Administrative multianalyte assays with algorithmic analyses
|
0
|
1
|
0
|
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TOTAL
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224
|
93
|
74
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