The new year brings ushers in an expanded Current Procedural Terminology (CPT®) code set and new challenges for medical coding professionals who need to keep up with the numerous changes issued each year by the American Medical Association (AMA). For 2024, the CPT code set includes 230 new codes, 49 deletions, and 70 revisions designed to keep pace with innovations in medical science and health technology.
To assist with coder and clinical staff education on the 2024 CPT code set changes, which are detailed in our e-book “2024 Current Procedural Terminology (CPT) Code Set Overview,” we’ve compiled the following highlights.
E/M Section Updates
The 2024 E/M section includes one new and 10 revised codes. The 2024 CPT guidelines for time in the introduction section 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 time ranges from both the new and established office/outpatient E&M codes and replace them with a single total time amount which “must be met or exceeded.” In other words, each clinician's billing based on time will have a single minimum time threshold that must be met or exceeded.
Also notable are changes to Split or Shared Visits, which are E/M visits where both a physician and nonphysician practitioners (NPP) in the same group each personally performs part of a visit that each one could otherwise bill if provided by only one of them. CMS pays the provider who performs the “substantive portion” of the visit, which for Medicare billing purposes in 2024 means more than half of the total time spent by the physician or NPP performing the split (or shared) visit, or a substantive part of the medical decision making (MDM).
- If the code level is selected using time, then the professional who spends the most time during the encounter reports the service.
- If MDM is used, the individual who approves the care plan and takes responsibility related to risk management performs the substantive portion of the visit.
- If data is used to select the MDM level, only the person who performs an independent interpretation or discussion of management or test interpretation may use those categories.
Per CMS, use modifier FS (Split or Shared E/M Visit) on claims to report these services, which indicates that even though a claim is being submitted under one provider, more than one provider performed the visit.
Other notable updates to the E/M section include:
- 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 of total time, and subsequent visit 99308 will require 20 minutes.
- One new add-on code (+99459) for pelvic examination, which is valued for practice expense only and used with office or other outpatient, consultation, and preventive medicine codes.
- Eight new guidelines for multiple same-day E/M visits in the hospital and nursing facility settings.
Surgery Section Revisions
Surgery is another section that was significantly altered for 2024, with 23 new codes and 10 revised codes. This includes three new codes (22836-22838) to report vertebral body tethering and instructional guidance to append modifier 62 to these procedure code when two surgeons work together to perform distinct parts of the thoracic vertebral body tethering procedure.
Two new CPT codes (31242 and 31243) were created for the endoscopic destruction of posterior nasal nerve (PNN) for use when reporting bilateral procedures. For unilateral procedure, use modifier 52.
The Surgery/Cardiovascular System/Heart and Pericardium Pacemaker or Implantable Defibrillator subsection has eight new codes (33276-33288) for reporting insertion, removal, repositioning, and replacement of phrenic nerve stimulator system and/or its components. New guideline language and parenthetical notes have been established to provide instruction on the appropriate reporting.
Four new CPT codes (93150-93153), guidelines, and parenthetical instructions have been added to the new subsection of “Phrenic Nerve Stimulation System” to accommodate reporting for therapeutic activation service. These codes may be reported when separate programming or interrogation services are required and may not be reported for phrenic nerve stimulation system services performed on the same day.
CPT code 52284 has been added to report cystourethroscopy with mechanical urethral dilation and therapeutic drug delivery via drug-coated balloon catheter for male urethral stricture or stenosis, including fluoroscopy, if performed. It specifically includes cystoscopy, urethral dilation, and drug delivery using a drug-coated balloon catheter.
One new category one CPT code (67516) has been added to capture suprachoroidal space injection of a pharmacologic agent. Additionally, new code 58580 was established to report transcervical fibroid ablation (TFA) and three new codes (61899, 61891, and 61892) were created to report skull-mounted cranial neurostimulator.
Radiology and Pathology & Laboratory Updates
The 2024 CPT code set updates to the Radiology Section include one new code (75580) to report non-invasive estimate of coronary fractional flow reserve (FFR) derived from augmentative software analysis of coronary computed tomography angiography data. There are also four new codes (76984, 76987, 76988, and 76989) added to the radiology “other procedures” section for reporting diagnostic intraoperative ultrasound services.
Changes to the Pathology and Laboratory Section include 75 additions, 25 revisions, and 15 deletions. The most notable changes to the Pathology Section include editorial updates to nine codes in Tier 1 (81171, 81172, 81243, 81244) and Tier 2 (81403-81407) molecular pathology procedures. Other changes include new definitions and revisions made to molecular multianalyte assays guidelines, revisions to codes (81445-81456), and six new codes (81457-81459 and 81462-81464). A new table was also created to aid coders in making the code selection less complex.
Finally, 61 new proprietary laboratory analyses (PLA) codes were established to describe PLAs provided by either a single laboratory or licensed/marketed to multiple providing laboratories.
Medicine Section Revisions
Updates to the Medicine Section include 43 additions and 12 revisions. Many are related to reporting and tracking COVID-19 vaccinations, including vaccine-specific administration codes (0001A-0174A) and vaccine product codes (90476-90759 and 91300-91317).
Appendix Q was also updated to reflect the new COVID-19 vaccination code additions and the appendix now includes a new column that provides the age of the patient for the product. Other changes to Medicine include:
- Five new venography add-on codes to report venography for congenital heart disease (93584-93588).
- A new subsection within Physical Medicine and Rehabilitation/Therapeutic Procedures with three new codes (97550-97552) and instructional guidelines for caregiver training.
- New guidelines, parenthetical notes, and two new codes (92622 and 92623) were added to capture auditory osseointegrated device services.
Category III Changes
Some of the most significant updates in the 2024 CPT code set were made to Category III, with 82 new codes, 13 revisions, and 32 deletions. Category III codes are a set of temporary codes to capture emerging procedures, services, technology, and service paradigms.
Two new codes enable reporting of percutaneous insertion or replacement of integrated neurostimulator electrode arrays of the spine (0784T) and sacrum (0786T). Two other new codes enable reporting of revisions and removals of percutaneously placed integrated neurostimulator electrode arrays of the spine (0785T) and sacrum (0787T).
Four codes (0816T-0819T) were established to report open insertion or replacement of integrated neurostimulator services for the posterior tibial nerve and their revisions or removals. The codes describing tibial nerve stimulator procedures for bladder dysfunction for insertion or replacement (0587T), or revision or removal (0588T) were also revised with the addition of terminology reflecting their use for the treatment of bladder function and to report percutaneous insertion or replacement of integrated neurostimulator services for the posterior tibial nerve.
Another notable revision was the addition of three new codes (0820T to 0822T), a new heading “Continuous In-Person Monitoring and Intervention During Psychedelic Medication Therapy,” and new guidelines to report continuous in-person monitoring and intervention provided during and following supervised patient self-administration of a psychedelic medication in a therapeutic setting.
Other noteworthy changes include:
- New code 0810T to describe the delivery of a pharmacologic agent into the subretinal space in the posterior segment of the eye.
- Four new codes (0823T-0826T), a new subheading, new guidelines, and a new table to report right atrial leadless pacemaker.
- Two new codes (0859T and 0860T) to report noncontact near-infrared spectroscopy.
Education Targets
Keeping up with the numerous CPT code changes issued annually by the AMA can be difficult, which is why coder education is vital for coding professionals to perform their jobs accurately and effectively. Accurate coding ensures facilities, physicians, and organizations have the data needed to support high-quality patient care and impacts timely and proper reimbursement at a time when few healthcare organizations can afford even brief revenue cycle delays.
Physicians and other clinical staff members should also be educated on key changes and their potential impact on clinical documentation to ensure coders are able to code to the highest level of specificity. Doing so allows the healthcare organization to optimize reimbursements – and the bottom line.
Proper education and planning on the CPT code updates should include updates to applicable systems and processes – encoder software, computer-assisted coding tools, physician queries and superbills – can also result in faster claim submission, avoid denials, and prevent regulatory audits from outside agencies.
Additional Resources
To ensure medical coding and other impacted professionals are up to speed on the 2024 CPT code set, review the guidelines and code changes in their entirety and make sure all applicable team members – including coders, physicians, and documentation specialists – are educated regarding the code and documentation requirements.
When it comes to integrating 2024 CPT code set changes into the organization’s coding process, many find it is most effective and efficient to enlist the assistance of a third-party to help with the heavy lifting.
To help prepare medical coding and documentation teams for the CPT code updates and guidelines, AGS Health has published in the 2024 Current Procedural Terminology (CPT) Code Set Overview. Also, view our on-demand webinar, 2024 Current Procedural Terminology (CPT) Code Set: What’s New And What’s Changed - AGS Health.
Author
