Lori A. Cox
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Since very early on in my career, one of my bucket list items has been to attend the CPT® Symposium. Getting to meet providers and AMA staff in charge of the CPT® changes every year made me feel like I would be at a VIP event with celebrities. So this year, when I was offered the chance to go, it felt like a dream come true.
Even though this year’s event was virtual, the attendees could ask questions in several Q&A sessions. The speakers were great at explaining the changes for 2022, and the AMA even threw in some fun events like a virtual comedy hour, games, and a $25 gift card to have DoorDash deliver lunch on one of the days. I came out of the symposium filled to the brim with information. The AMA also provided all attendees with the 2022 CPT® Changes: An Insider’s Viewbook that gives rationales for the changes and clinical examples. Put this on your must-do list if you’ve never been because it is truly amazing. Almost as good as AAPC’s HealthCon!
There was too much information to get it all on this eBrief, but here are a few of the changes that I thought were important. These changes go into effect on January 1, 2022, and of course, you can find them all in your 2022 CPT® codebook.
Evaluation & Management (E/M)
The most significant change here relates to adding codes for Principal Care Management (PCM). Similar to Chronic Care Management which is the oversight of 2 or more chronic conditions, PCM is the oversight of a single chronic condition that is expected to last at least three months. Requirements include:
- At least 30 minutes per month
- Condition must place patient at significant risk
- Development, monitoring, or revision of care plan
- Frequent medication adjustments
- Ongoing communication between relevant providers
The codes are based on whether a provider or clinical staff is doing the management and time spent. Many tables were added to assist with correct code selection. Because of these new codes, many guidelines and parenthetical notes in other E/M categories were revised.
Anesthesia and Pain Management
Six new codes were added to adequately code for the anesthesia for radiological procedures on the spine, such as percutaneous injections, destructions, and intravertebral procedures.
New codes have been added for thermal destruction of spinal nerves, 64628 and 64629. This new procedure uses radiofrequency to destroy the basivertebral nerve, which can relieve chronic low back pain.
Surgery
In the Surgery section guidelines, a clarification has been made regarding the difference between a “foreign body” and an “implant.” If an implant has moved or broken, it becomes a foreign body.
Integumentary
Revised code 11981 to include insertion of bioresorbable and biodegradable implants. The definition of a simple repair was also clarified. Many people thought these codes could be reported when sutures were not used, which was incorrect. A simple repair, sutures, staples, or glue must be used to bill.
Musculoskeletal
Many guideline and definition clarifications were made in this section, mainly centered around fracture and dislocation services.
The guidelines now state that the placement and removal of the first cast, splint, or traction device are included in all services in the MS section. ALL services! This is probably my favorite clarification for 2022. Any subsequent casts, splints, or devices can be billed separately.
The definitions of manipulation closed treatment, and external fixation were also updated. AMA describes exactly what each of these procedures entails, such as how a manipulation is the reduction of manually applied forces and closed treatments are not surgically opened.
The spinal fusion codes received a plethora of note upgrades. Definitions and images were added, as well as revisions to parenthetical notes. No actual code changes, but make sure you read those new guidelines and notes.
Cardiovascular
New codes were added to exclude the left atrial appendage (LAA). 33267 is used when the LAA is stapled, oversewn, ligated, etc., via an open approach. 33268 is used when performed during another open procedure, and 33269 is used when the exclusion is performed via thoracoscopy.
The guidelines and notes for aortic, mitral, and pulmonary valve replacements are updated thanks to the extensive overhaul of the cardiac catheterization codes in the Medicine section.
A new code, 33509, was added for harvesting an upper extremity artery for a CABG via endoscopy. We also have three new codes, 33894, 33895, 33897, for endovascular repair of congenital heart and vascular defects.
Gastroenterology
One main code change here, the addition of 42975 for a drug-induced sleep endoscopy. This was previously reported with 31575, 31622, or 92502, but these codes do not adequately capture the work involved. We also have a new code for transoral endoscopic esophageal myotomy – 43497.
Urinary and Genital Systems
Category III codes 0548T-0551T have been switched to Category I codes 53451-53454. These codes are used for periurethral transperineal adjustable balloon continence devices. These devices are placed for patients suffering from incontinence.
We have new Category III codes for Uterus Transplantation. There are seven new codes: 0664T-0670T. There will be three codes used when doing these; the hysterectomy from the donor, the transplantation, and the backbench preparation of the uterus.
Nervous System
Two new laser interstitial thermal therapy (LITT) codes for intracranial lesions were created: 61736 for one simple lesion and 61737 for multiple or complex lesions.
AMA has clarified that fluoroscopic guidance and localization (code 77003) can be reported with the injection, drainage, and aspiration codes for spine and spinal cord procedures, except for 62263 and 62264. And due to the many changes in the musculoskeletal system codes, many parentheticals and guidelines were revised, added, or deleted. We also have two new codes for laminectomy, facetectomy, or foraminotomy with decompression during posterior interbody arthrodesis, single (63052) and each addition segment (63053).
Eyes & Ears
Category III codes 0191T and 0376T were converted to codes 66989 and 66991 to report cataract removal with insertion of anterior intraocular segment aqueous draining devices.
A new section was created in the middle ear heading for two new codes describing osseointegrated implants into the skull, 69716 and 69719, and revisions to the two existing codes, 69714 and 69717.
Radiology
Four new codes for trabecular bone score (TBS) procedures were created: 77089, 77090, 77091, 77092. TBS measures the structural condition of the bone microarchitecture. A high value is good bone structure; a low value means the bone is incomplete and at risk of fracture.
Pathology
The pathology clinical consultation codes 80500 and 80502 were deleted, and new codes 80503, 80504, 80505, 80506 were created. Based on MDM or Time, these codes are now leveled just like the office visits. The prolonged code 80506 requires at least 16 minutes of extra time and only uses 80505. A table has been added to the book for easier level selection.
Many of the rest of the revisions and additions result from ongoing needs to report COVID-19.
Medicine
The codes for administering vaccines received parenthetical notes also related to COVID-19. New codes were created for the administration of the vaccine and the vaccine itself.
90785 – interactive complexity. This is an add-on code used with other psychotherapy and psychiatric codes when specific difficulties make it harder to work with the patient. Examples include ineffective communication with the patient(s), emotions or behaviors that interfere heavily with treatment, etc. These are all listed in the updated guidelines for this code. This code can no longer be added to E/M visits alone as it was previously.
94625 & 94626 – Pulmonary rehabilitation. These new codes are for patients in an outpatient rehab program for COPD, asthma, etc. They require the physician to be immediately available during the exercise session, review systems and the patient’s medical record, and a face-to-face evaluation. The most significant change in this section is to the cardiac catheterization codes. If you code these (my sympathies!), you’ll want to read the updated guidelines very carefully. The changes are due to creating the new codes for Cardiac Catheterization for Congenital Heart Defects, 93593-93598. Because of these new codes, the guidelines and parenthetical notes have all been updated.
Thanks again, mainly to COVID-19, we have a new section for Remote Therapeutic Monitoring and Remote Therapeutic Treatment Management Services. These codes are intended to report the monitoring of data related to signs, symptoms, and functions of a therapeutic response. Codes 98975-98977 are used for the initial set up of the equipment and device supplies for the respiratory and musculoskeletal systems. Codes 98980-98981 are reported once per month for the time spent.
There are many new Category III codes due to emerging innovations in healthcare and a couple of updates in the Appendices.
Every year when I get my CPT® book, I spend some time transferring notes from my previous book and reading through guidelines for my specialties – even guidelines that haven’t changed. It’s a great refresher! During the symposium, they also talked about the issues with the new 2021 E/M Office Visit Guidelines and how/why the changes were made. The AMA said this was the biggest attendance at a symposium that they’ve ever had – over 1500 people! There were many networking opportunities and a chance to win a free registration for the 2023 CPT® Symposium. Maybe I’ll see you there next year!
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