Part One of this three-part blog series on the 2022 CPT code set explored the factors driving some of the most noteworthy changes taking effect on January 1, 2022. In Part Two, we take a deep dive into the changes to the Evaluation and Management (E&M) and Surgery sections.
E&M and Surgery sections represent a combined 35 new CPT codes, 35 revisions, and nine deletions in the 2022 Current Procedural Terminology (CPT) code set from the American Medical Association (AMA), which took effect on January 1, 2022 – many of which were driven by innovations and advances in technology and digital health services.
E&M Section Updates
For example, E&M was expanded to include a new heading – Principal Care Management (PCM) Services – and new time-based CPT codes (99424, 99425, 99426, 99427) for PCM services, focused on establishing, implementing, revising, or monitoring a care plan that is specific to a disease for medical and/or physiological needs that are displayed for a single, complex chronic condition. Patients covered by PCM codes must have one complex chronic condition lasting at least three months as well as one of the following criteria:
- The condition places the patient at significant risk of hospitalization, acute exacerbation, functional decline, or death.
- The condition requires development or revision of a disease-specific care plan.
- The patient was recently hospitalized due to the condition.
- The patient requires frequent adjustments in the medication regimen and/or the management of the condition is unusually complex due to comorbidities.
Further, the Critical Care Services guideline has been revised to include an updated list of services that are included in critical care when performed during the critical period by the physician(s) providing critical care. The updated list includes:
- Interpretation of cardiac output measurements (93598), chest X rays (71045, 71046), pulse oximetry (94760, 94761, 94762) [blood gases, and collection and interpretation of physiologic data]
- Gastric intubation (43752, 43753)
- Temporary transcutaneous pacing (92953)
- Ventilatory management (94002-94004, 94660, 94662)
- Vascular procedures (36000, 36410, 36415, 36591, 36600)
Any services performed that are not included in this listing should be reported separately.
Further, the E&M Care Management Services Chronic Care Management and Complex Care Management services sections have both CPT guideline and code revisions. As such, those responsible for assigning these two sections of codes (99490, 99491, 99439, 99437, 99487, 99489) should review all CPT guideline updates, new parenthetical notes, and updated code descriptions and make sure all coders, physicians, and applicable staff are ready for these key code changes and documentation requirements.
Surgery Section Revisions
Surgery is another section that was significantly altered for 2022, with 30 new codes, 25 revised codes and nine deletions. These include two guideline revisions under Integumentary System-Repair (Closure) to note chemical cauterization, electrocauterization or wound closure using adhesive strips as the sole repair material is included in the appropriate E&M code. Guidelines were also revised to clarify that when hemostasis and local or topical anesthesia are performed in conjunction with simple repair they are not coded separately.
In terms of the Musculoskeletal System, all introductory guidelines have been revised and reorganized to clarify fracture and dislocation treatment services. They now state that the application and removal of the first cast, splint, or traction device is included in all services in the musculoskeletal system section. If the cast, splint, or traction device is removed by someone other than the physician or other qualified healthcare professional who applied it, a cast removal code (29700, 29705, 29710) should be used to report it.
Further, the definitions for external fixation, closed treatment, and manipulation have been revised with added clarification of the work included in these types of treatment. Within the manipulation definition it notes that “if satisfactory alignment (reduction) is not maintained and requires subsequent re-reduction of a fracture or dislocation by the same physician or same qualified healthcare professional, append modifier 76 to the fracture/dislocation treatment.”
The guidelines, definitions, and instructional notes related to the spine were also revised and updated throughout the codes for arthrodesis, posterior or posterolateral techniques of the cervical, thoracic, and lumbar bones (22600-22614), for spine fusion procedures that describe posterior interbody fusion techniques (22633, 22634), and for laminectomy code 63048. The updated guidelines offer clarity on when a laminectomy, facetectomy, and/or foraminotomy procedure(s) can be coded alongside a specific fusion or arthrodesis procedure.
New codes 63052 and 63053 have been established to provide appropriate reporting for laminectomy when performed in conjunction with fusion of the lumbar vertebra. The guidelines also now clearly note that “decompression solely to prepare the interspace for fusion is not separately reportable”. In this section, anatomy terms and illustrations have also been updated to further assist in better understanding of the procedures and reporting.
Cardiovascular System—Electrophysiologic Operative Procedures has three new CPT codes (33267, 33268 and 33269) to reflect exclusion of the left atrial appendage (LAA). Code 33267 is used for LAA exclusion by any method via an open approach; code 33268 is used for LAA exclusion by any method via an open approach performed at the same time of other sternotomy or thoracotomy procedure(s); and 33269 is used for LAA exclusion via thoracoscopy. New guidelines have also been added to this section to aid in accurate CPT code assignments.
Cardiovascular System—Endoscopy now includes CPT code 33509, created report an endoscopic harvest of the upper extremity for coronary artery bypass. Finally, Cardiovascular System- Endovascular Repair of Congenital Heart and Vascular Defects was expanded with three new codes (33894, 33895, 33987), a new subsection, and guidelines to describe endovascular repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta. CPT codes 33894 and 33895 include stent placement, while 33897 was added to report endovascular angioplasty of native or recurrent aortic coarctation without the use of a stent.
Other notable changes to the Surgery Section include:
- Four new CPT codes (53451,53452,53453, and 53454) under Urinary System—Urethra to report periurethral transperineal balloon-continence device procedures including codes for insertion, removal, and adjustment of these devices.
- Two new codes (61736, 61737) under Nervous System—Skull, Meninges, and Brain to report laser interstitial thermal therapy (LITT) – which involves the stereotactic placement of a laser fiber into an intracranial target lesion – for treatment of intracranial lesion(s).
- Creation of CPT codes 64582-64584 under Nervous System- Neurostimulators to report hypoglossal nerve stimulation services including implantation, revision, and removal of the stimulation device.
Rounding out the Surgery Section changes, under Eye and Ocular Adnexa-Intraocular Lens Procedures, Category 3 codes (0191T and 0376T) have been deleted for 2022 and two new Category 1 CPT (66989 and 66991) codes were added to report various insertion procedures for the placement of an anterior segment aqueous drainage device into the trabecular meshwork without an external reservoir. New guidelines and notes were also added to provide instructional guidance on the intent and use of these new codes.
Part One of this series took a high-level look at some of the driving factors behind the most noteworthy changes to the 2022 CPT code set. Next, Part Three takes a closer look at changes to the Anesthesia, Pathology and Laboratory, Medicine and Category III sections. Once you’ve read the blog series, it’s time to determine how to implement the revised code set into your organization’s coding process.
AGS Health offers multiple solutions to prepare your team further for the CPT code updates. We would love to talk to you further about our tools and services to support your team with the use of the numerous code updates and guidelines. Contact us for more information.
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