CPT & E/M coding has various updates coming every year. While our CPT code list is not exhaustive, it is thorough, simple to navigate, and easy to understand. So when patients arrive, be sure to verify their insurance, note any changes to their policies and collect the deductible. The evaluation and management category has a number of CPT code changes for 2021. The CPT & E/M coding changes were made in an effort to respond to the fast pace of innovation among digital-medicine services. This article provides you the frequently asked questions on CPT & E/M coding updates.
Is G0297 HCPCS code being deleted?
- Yes, HCPCS code G0297, Low dose CT scan (LDCT) for lung cancer screening, is no longer available from January, 2021. The new Current Procedural Terminology (CPT) code 71271, Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s), will be available to report.
From the E/M changes to codes 99201-99355, is HCPCS code G0463 still an acceptable alternate code?
- Yes, HCPCS code G0463, Hospital outpatient clinic visit for assessment and management of a patient is still the Medicare-preferred code. Although CPT code 99201 is being deleted, facilities should still use their own internal guidelines for code selection.
For lab codes, when do we use the Proprietary Laboratory Analyses (PLA) codes versus the Tier I or Tier II codes?
- When a PLA code is available to report a given proprietary laboratory service, that PLA code takes precedence. Reporting the PLA code is restricted to the specific proprietary laboratory test and is always performed by a specific laboratory. Otherwise, the appropriate CPT Category I code, which may be a Tier I or Tier II code, should be reported.
Can new CPT code 0631T be used for a transcutaneous oximetry (TCOM) service prior to hyperbaric oxygen (HBO) therapy?
- The use of CPT code 0631T, transcutaneous visible light hyper-spectral imaging measurement of oxyhemoglobin, deoxyhemoglobin, and tissue oxygenation, with interpretation and report, per extremity, is done to obtain tissue oxygenation measurements. This is to identify areas of reduced blood flow and ischemic tissue in an extremity. It is possible that this may be used, as long as an interpretation and report is performed.
Is the Level 1 CPT code for E/M services being deleted?
- Yes, CPT code 99201, Office or other outpatient visit for the evaluation and management of a new patient requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies is provided consistently with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. It has been deleted after December 31, 2020. The American Medical Association (AMA) suggests CPT 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 time for code selection, 15-29 minutes of total time is spent on the date of the encounter, as a replacement. The AMA stated that a new patient would require a higher level of medical decision making (MDM), and deletion of 99201 would mean that the MDM for new and established patients would have four levels.
If a healthcare facility does not perform the interpretation and the report, will they be able to report the new code 92653?
- CPT code 92653, Auditory evoked potentials; neuro-diagnostic, with interpretation and report, is assigned to status indicator S, Procedure or Service, Not Discounted When Multiple, and is assigned to Ambulatory Payment Classification 5722, Level 2 Diagnostic Tests and Related Services. The National Payment Rate (NPR) is $264.45. This payment is for the technical portion provided by the facility. The physician’s professional claim will reimburse for the professional component of the interpretation and report.
How will the new drug testing codes affect the G0480-G0483 definitive drug tests?
- The new drug assay codes 80143-80210 are therapeutic drug assays and are used to monitor levels of a known, prescribed, or over-the-counter medication. These particular tests are therapeutic assays and include immunoassays. These types of tests are excluded from the definitive drug testing definition. Definitive drug identification methods include gas, chromatography with mass spectrometry and liquid chromatography mass spectrometry.
Are new HCPCS codes G2211 and G2212 chargeable/reportable on the hospital billing side?
- HCPCS codes G2211, Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established), and G2212, Prolonged office or other outpatient evaluation and management services beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99205, 99215 for office or other outpatient evaluation and management services) (do not report G2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416). (Do not report G2212 for any time unit less than 15 minutes), are both assigned to status indicator N, Items and Services Packaged into APC Rates. The CPT & E/M codes are reportable, but the reimbursement will be packaged into the reimbursement for the primary E/M service.
Is CPT code 19370 used in addition to or in place of CPT code 11970?
- CPT code 11970, Replacement of tissue expander with permanent implant, does include minor revisions to the breast capsule. CPT code 19370, Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy, may be reported in addition to CPT 11970 if a more extensive capsular revision is performed. There is a National Correct Coding Initiative (NCCI) edit in place, but a modifier may be appropriate.
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