Take a glimpse at the hundreds of CPT coding updates coming in 2024 to prepare your coding and billing staff for a successful turn of the calendar. You’ll find new codes, as well as code revisions, spread throughout the CPT manual, in addition to important guideline updates.
Also, nearly 50 codes are on the chopping block. All coding updates, outside of a separately announced
COVID vaccine consolidation that takes effect Nov. 1, 2023, will be effective Jan. 1, 2024.
Evaluate E/M timing changes
The 2024 manual updates the guidelines for time in the introduction to make it clear that the mid-point concept does not apply to E/M services that have a total time threshold.
Specifically, office visit codes 99202-99205 and 99212-99215 have been revised to remove the code range from each code Instead, clinicians billing based on time will have a single minimum time threshold that must be met or exceeded.
Practices shouldn't be alarmed by this; the editorial updates simply change the codes’ format to match the rest of the level-based E/M codes. They do not change the threshold time that the treating practitioner must meet to select a code based on time.
Consider the descriptor changes for code 99202: (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15-29 minutes of total time is spent on the date of the encounter minutes must be met or exceeded).
However, practices that report visits in the nursing facility setting should note the five-minute time increase for two visits. When a practice reports a visit based on time initial visit, 99306 will require 50 minutes total time and subsequent visit 99308 will require 20 minutes of total time.
The sole new addition to the E/M code set is a new add-on code, 99459 (Pelvic examination [List separately in addition to code for primary procedure]).
Spot split or shared updates
The new CPT guidelines for split or shared services will look familiar if you’ve studied Medicare’s rules for E/M visits performed by a physician and qualified health care professional (QHP) care team. The CPT guidelines adopt the concept of calculating the substantive portion to determine which team member reports the visit.
If a practice codes a visit based on time, the practitioner who spends the majority of time on the date of the encounter reports the service. Keep in mind that physicians and QHPs can continue to select a code based on their combined time.
If a practice codes the visit based on medical decision-making (MDM), the practitioner who performs the problems addressed and risk portions of the visit reports the service.
The E/M update also includes eight new guidelines for multiple same-day E/M visits in the hospital and nursing facility settings. For example, you should report a subsequent service (99231-99233 or 99307-99310) if a patient is discharged and readmitted to the same facility on the same date.
Musculoskeletal: Spine, sacroiliac joint and hallux valgus code changes
Spine surgeons will have three new Category I codes to report for vertebral body tethering at the thoracic level, including code 22836 (Anterior thoracic vertebral body tethering, including thoracoscopy, when performed; up to seven vertebral segments), 22837 ( ... ; eight or more vertebral segments) and 22838 (Revision [eg, augmentation, division of tether], replacement, or removal of thoracic vertebral body tethering, including thoracoscopy, when performed). The codes include thoracoscopy, when performed. In addition, Category III codes for vertebral body tethering (0656T and 0657T) will remain in the code set and be revised to describe placement of the devices in the lumbar or thoracolumbar regions.
All the vertebral tethering codes describe access via anterior approach, which in most cases is done with an endoscope. The implants are an alternative to spinal fusion to correct progressive scoliosis while allowing natural growth and mobility of the spine. Anchors and bone screws are placed in the vertebrae above and below the spinal curvature, and a tether cord is secured to the bone screws, to which the surgeon can apply tension to straighten the spine.
- Percutaneous sacroiliac joint fusion. A new Category I code, 27278, replaces deleted Category III code 0775T for percutaneous sacroiliac joint arthrodesis (fusion) when bone allograft is placed. Code 27278 clarifies that it does not describe placement of a transfixion device across the sacroiliac joint. Instead, report code 27279.
- Hallux valgus correction codes receive a clarification. Codes 28292, 28295, 28296, 28297, 28298 and 28299 are revised to state that they describe hallux valgus correction “with bunionectomy.” Previously, the code language stated: “Correction, hallux valgus (bunionectomy).”
Note nervous system additions
The 2024 CPT manual introduced three permanent codes for integrated neurostimulators: 64596 (Insertion or replacement of percutaneous electrode array, peripheral nerve, with integrated neurostimulator, including imaging guidance, when performed; initial electrode array). There is an add-on code for additional arrays (64597) and code for revisions or removal of the system (64598). Integrated systems don’t require a separate pulse generator.
The new codes triggered revisions to four existing neurostimulator codes. For example: 63685 (Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling, requiring pocket creation and connection between electrode array and pulse generator or receiver). There are two new Category III codes, also known as T codes, for integrated spinal neurostimulators.
Radiology: Intraoperative ultrasound and noninvasive coronary fractional flow reserve
Practices will have one new Category I code (75580) that describes non-invasive estimate of coronary fractional flow reserve (FFR) based on software analysis of coronary CT angiography data. The new code replaces five deleted Category III codes (0501T-0508T).
Four new codes will allow reporting of diagnostic intraoperative ultrasound; code 76984 describes ultrasound of the thoracic aorta (e.g., epiaortic), while 76987-76989 allow reporting of intraoperative epicardial cardiac ultrasound for congenital heart disease.
Discover more changes
Anesthesia and surgical groups should take note of 97037, a new code for low-level laser therapy (LLLT) to treat post-operative pain. Practices should watch for more information on coverage from their payers before they purchase an LLLT device.
The 2024 CPT manual granted permanent code status to a variety of services such as percutaneous transluminal coronary lithotripsy (add-on code 92972), which are currently reported with Category III codes, which could translate into smoother coding and more revenue. The manual also contains eight new phrenic nerve stimulator codes (33276-33281 and 33287-33288), which will replace 12 T codes (0424T-0436T) and cystourethroscopy code 52284 will replace 0499T.
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CY2024 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 (99202-99499)
|
1
|
10
|
0
|
|
Anesthesia (00100-01999)
|
0
|
0
|
0
|
|
Integumentary system (10030-19499)
|
0
|
0
|
0
|
|
Musculoskeletal system (20100-29999)
|
4
|
6
|
0
|
|
Respiratory system (30000-32999)
|
2
|
0
|
0
|
|
Cardiovascular system (33016-37799)
|
8
|
0
|
0
|
|
Digestive system (40490-49999)
|
0
|
0
|
0
|
|
Urinary system (50010-53899)
|
1
|
0
|
0
|
|
Male genital system (54000-55899)
|
0
|
0
|
0
|
|
Female genital system (56405-58999)
|
1
|
0
|
0
|
|
Nervous system (61000-64999)
|
6
|
4
|
0
|
|
Eye and ocular adnexa (65091-68899)
|
1
|
0
|
0
|
|
Auditory system (69000-69979)
|
0
|
0
|
0
|
|
Radiology (70010-79999)
|
5
|
0
|
1
|
|
Pathology and laboratory (80047-89398), (0001U-0284U)
|
75
|
25
|
15
|
|
Medicine (90281-99607), (0001A-0144A)
|
43
|
12
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0
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|
Category III (0001F-9007F)
|
82
|
13
|
32
|
|
Administrative multianalyte assays with algorithmic analyses
|
1
|
0
|
1
|
|
TOTAL
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230
|
70
|
49
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