The American Medical Association (AMA) CPT code is updated once a year. Medical billing and coding organizations rely on professionals to keep records of these changes and appropriately record and document CPT codes for services given. The 2021 CPT code set has 329 modifications, including 206 new codes, 54 removals, and 69 amendments, and entered into effect on January 1. Let’s have a look at the most significant changes.
Office and other Outpatient Evaluation and Management (E/M) Services Revised Codes: One of the most major modifications for 2021 is revised E/M office visit codes. Code 99201 has been removed for office or other outpatient visits to evaluate and care for a new patient.
Other significant E/M office visit code changes include the elimination of history and physical exam as code selection components, a transition in the description of ‘time’ associated with 99202-99215, the ability to select code level regarding medical decision-making, and the participation of more detail in CPT code descriptors to assist payer consistency.
Prolonged Services: For reporting longer services in conjunction with an office visit, a new code – 99417 – has been created. Code 99417, which replaces CPT codes 99354 and 99355, indicates the entire length of time spent with and without patient contact on the same day as an office visit. Certain regulations apply to using a new code for extended services: 99417 can only be submitted in conjunction with level 5 visit codes (CPT 99205, 99215).
- The period must be longer than the minimum for primary E&M service.
- Coding should be done solely based on time.
Services for Chronic Care Management (CCM): Code 99490 is reported at the 20-minute point. Code 99439 is the new code for an extra 20 minutes. For each extra 20 minutes of clinical staff time, code 99439 is recorded in combination with code 99490.
Cardiovascular: There are new cardiac rerouting operation codes. The codes 33741 and 33745 are used to report the generation of efficient intracardiac blood flow in the presence of congenital heart abnormalities. Code 33746 is assigned to each additional intracardiac shunt site and must be reported in combination with code 33745).
33741 Transcatheter atrial septostomy (TAS) for congenital cardiac abnormalities to establish efficient atrial flow, including all imaging supervision by the Proceduralist, any technique (e.g., Rashkind, Sang-Park, balloon, cutting balloon, blade)
33745 TIS creation for congenital cardiac anomalies to establish effective intracardiac flow, all imaging guidance by the Proceduralist when performed, left and right heart diagnostic cardiac catheterization for congenital cardiac anomalies when performed.
The code 33746 is assigned to each subsequent intracardiac shunt created by stent implantation at a different site during the same session as the original operation (33745).
Audiologic Function Tests: Three new codes have been added to the auditory evoked potentials category.
92651 refers to nonautomated follow-up electrophysiologic testing to rule out substantial hearing loss, such as auditory neuropathy/auditory Dyssynchrony, or to confirm the necessity for further threshold testing.
92652 offers a detailed electrophysiologic assessment of behavioral hearing thresholds at many levels and frequencies employing broadband and frequency-specific stimuli.
94617 has been updated to introduce new code 94619, which defines exercise testing without electrocardiographic (ECG) monitoring.
94617 Bronchospasm exercise testing, including pre-and post-spirometry and pulse oximetry; with the electrocardiographic recording (s).
94619 Bronchospasm exercise testing Spirometry and pulse oximetry are included, but no electrocardiograms are recorded (s).
Other CPT code changes include new and revised codes to enhance screening and care of patients with diabetes. Update to Revised breast reconstruction codes, nervous system codes, significant expansions to the descriptions of arthroscopic shoulder debridement codes, addition of a lung cancer screening code, new ultrasound treatment code for cancer, and ob-gyn colposcopy mapping code. There are also new CPT codes for coronavirus testing.
These updates can be a challenging for physician practices. Outsourcing medical billing and coding to an expert is best to keep up with CPT code changes and report procedures and services correctly to federal and private payers for optimal reimbursement. We stay up to date on new rules and regulation of billing processes. We have skilled staff to guide you on issues regarding your billing. Please contact us at firstname.lastname@example.org
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