CY 2024 – CPT Update:
Let’s Take A Peek – What is New and Noteworthy?
A WEBINAR PRESENTED ON DECEMBER 6, 2023
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Presented By
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I,
CEMC, CRC, CCDS, CCDS-O, is the director of HIM and
coding for HCPro. She oversees all of the Certified Coder
Boot Camp programs. In addition, she specializes in
creating custom designed educational programs for
Propel Coding membership clients. McCall was one of the
original ACDIS Advisory Board members and one of the
contributors to the development of the CCDS-O
certification examination.
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Agenda
• New, and revised and deleted CPT codes
o Revision of time for E/M office visit codes
o Spinal tethering procedures
o Phrenic neurostimulator systems
o Skull-mounted cranial neurostimulator systems
o Intraoperative cardiac ultrasound procedures
o COVID-19 and respiratory syncytial virus (RSV) immunization codes
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Learning Outcomes
• At the completion of this educational activity, the learner will be able to:
– Apply new and revised CPT codes for 2024
– Recognize new E/M service descriptors
– Identify new CPT codes for surgical procedures
– Improve coding accuracy to reduce denials
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CPT Summary – 2024
CPT Chapter Additions Revisions Deletions
E/M 1 10 0
Anesthesia 0 0 0
Surgery 23 10 0
Radiology 5 0 1
Path/Lab incl 76 25 16
PLAs/MAAAs
Medicine 43 12 0
Category II 0 0 0
Category III 82 13 32
TOTALS 230 70 49
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General Guidance Clarifications – Introduction
• Clarifications added for Category I and III codes
– Do not unbundle components of a combination code description and report separately
• Example: Reporting tonsillectomy and adenoidectomy separately vs the combination
code that identifies both procedures
– Multiple Category I and III codes may be reported together if they describe the totality of the
services provided
– Procedural steps necessary to reach and close the operative site are not reported
separately unless instructed by the CPT guidelines
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General Guidance – Introduction
• – Audio-Video and Audio-only Telemedicine Services Criteria
– Appendix P (modifier-95) and Appendix T (modifier -93) for a list of codes
– Criteria:
• Must provide the same service as if it was in person
• Evidence supports the benefits of performing the service through telecommunication
technology.
– Facilitate a diagnosis/treatment plan to reduce complications plans
– Decrease diagnostic/therapeutic interventions
– Decrease hospitalization
– Decrease in-person visits to ER, offices, urgent care
– Increase rapidity of resolution
– Decrease quantifiable symptoms
– Reduce recovery time
– Enhance access to care for rural and vulnerable patients
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Evaluation and Management
• Additions – 1
• Revisions – 10
• Deletions – ZERO
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Evaluation and Management – Guidelines
• Split or Shared Visits
– Split-shared means a service provided in a facility setting whereby a physician and a non-
physician practitioner who are in the same group practice provide a portion of a visit to a
patient on the same date of service.
– The provider that bills for the service provides the “substantive portion”.
• AMA guidance:
– When using times as the leveling factor, the provider who spent the majority of the face-to-
face or non-face-to-face time performing the service.
– When using MDM as the leveling factor, the provider who made or approved the management
plan for the number and complexity of problems addressed and takes responsibility for that
plan and the inherent risk of complications/morbidity of patient management will determine
the appropriate level.
• CMS guidance concurs with the AMA E/M guidance <MPFS Final Rule>
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Evaluation and Management – Guidelines
• Three Contributory Elements of MDM (2 out of 3 must be met or exceeded)
– Number and Complexity of Problems Addressed
– Risk of Complications/Morbidity of Patient Management FOR SPLIT-SHARED VISITS
– Amount and/or Complexity of Data Reviewed and Analyzed Based on MDM
• Things that count as data:
– Review of tests (do NOT have to be personally performed by the provider reporting the split-
Considered shared service)
inherent to
formulating – Order of tests (do NOT have to be personally performed by the provider reporting the split-
management shared service)
plan
– Assessing independent historian narratives (do NOT have to be personally performed by the
provider reporting the split-shared service)
– Independent interpretation of tests (must be PERSONALLY performed by the provider
reporting the split-shared service if using for level selection)
– Discussion of management or test interpretation (must be PERSONALLY performed by the
provider reporting the split-shared service if using for level selection)
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Evaluation and Management – Guidelines
• Multiple E/M Visits on the Same Date of Service
– “Per day” codes – a single service is reported (aggregate MDM and time on the date of the
encounters)
– Time spent in the ED by a provider who provides subsequent E/M services may be included
in total time spent on the date of the encounter (barring ED service codes are not reported
99281-99285)
– If a patient is discharged and readmitted to the SAME facility on the same calendar date,
report a subsequent care service (99231-99233) instead of a discharge or initial service.
• Considered a single stay
• However, if discharged and admitted to a DIFFERENT facility, this constitutes a new
stay.
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Evaluation and Management
• 99202 – 15 minutes must be met or exceeded Eliminated time ranges
(e.g., 10-19 minutes)
• 99203 – 30 minutes must be met or exceeded only includes LEAST
• 99204 – 45 minutes must be met or exceeded amount of time be met
or exceeded
• 99205 – 60 minutes must be met or exceeded
• 99212 – 10 minutes must be met or exceeded
• 99213 – 20 minutes must be met or exceeded AMA CMS
• 99214 – 30 minutes must be met or exceeded
• 99215 – 40 minutes must be met or exceeded
The concept of surpassing the mid-point
of time does NOT apply.
<E/M Guidelines>
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Evaluation and Management
• “8-hour rule” is added!
– When a patient receives inpatient/OBS care for less than 8 hours only the initial care codes
may be reported (99221-99223) for the date of admission.
– Admission/discharge on the same DOS 8+ hours report “Admit/Discharge on the Same
Day” code (99234-99236)
• Two or more visits must be documented (admit and discharge)
• Do NOT report discharge services (99238-99239) for either situation
– New table added in CPT!
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Evaluation and Management
• 99306 – Initial nursing facility care, per day… high level MDM
– 50 minutes must be met or exceeded (increased from 45 minutes)
• 99308 – Subsequent nursing facility care, per day… low level MDM
– 20 minutes must be met or exceeded (increased from 15 minutes)
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Evaluation and Management
• +99459 – Pelvic examination (List separately in addition to primary procedure)
– May be used in conjunction with office visits, outpatient consultations, preventative medicine
visits
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HCPCS II – G2211
• G2211 – Visit complexity inherent to E/M associated with medical care services
that serve as the continuing focal point for all needed healthcare services
and/or with medical care services that are part of ongoing care related to a
patient’s single, serious or complex condition (list separately in addition to
office visits 99202-99215)
– Code was added in 2021 as part of the Consolidated Appropriations Act 2021 however,
delayed PFS payment until Jan 1, 2024.
– Was assigned status indicator “B” (bundled) until 2024.
– Reporting is not based on specialty but certain specialties may furnish these services more
than others (e.g., primary care).
– May be reported with any level office visit
– G2211 should not be assigned if payment modifiers such as -24, -25 or -53 are assigned.
<MCPM, Chapter 12, §30.6.7.F>
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Musculoskeletal System
• Additions – 4
• Revisions – 6
• Deletions – ZERO
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Musculoskeletal System
• 22836 – Anterior thoracic vertebral body tethering, including thoracoscopy,
when performed; up to 7 vertebral segments
• 22837 -- ; 8 or more vertebral segments
• 22838 – Revision (e.g., augmentation, division of tether), replacement, or
removal of thoracic vertebral body tethering, including thoracoscopy, when
performed
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Musculoskeletal System
• 27278 – Arthrodesis, sacroiliac joint, percutaneous, with image guidance,
including placement of intra-articular implant(s) (e.g., bone allograft[s], synthetic
device[s]), without placement of transfixation device
– Previously reported with 0775T
Modifier-50 if
– For percutaneous procedures utilizing a transfixation device, use 27279 bilateral
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Respiratory System
• Additions – 2
• Revisions – ZERO
• Deletions – ZERO
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Respiratory System
• 31242 – Nasal/sinus endoscopy, surgical; with destruction by radiofrequency
ablation, posterior nasal nerve
• 31243 -- ; with destruction by cryoablation, posterior nasal nerve
Inherently a bilateral
procedure, if unilateral
add modifier-52
Treatment area
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Cardiovascular System
• Additions – 8
• Revisions – ZERO
• Deletions – ZERO
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Cardiovascular System
• 33276 – Insertion of phrenic nerve stimulator system (pulse generator and
stimulating lead[s]), including vessel catheterization, all imaging guidance, and
pulse generator initial analysis and diagnostic mode activation, when
performed
• +33277 – Insertion of phrenic nerve stimulator transvenous sensing lead
• 33278 – Removal of phrenic nerve stimulator, including vessel catheterization,
all imaging guidance, and interrogation and programming, when performed;
system, including pulse generator and lead(s)
• 33279 -- ; system, transvenous stimulation or sensing lead(s) only
• 33280 -- ; system, pulse generator only Semi-colon
placement?
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Cardiovascular System
• 33281 – Repositioning of phrenic nerve stimulator transvenous lead(s)
• 33287 – Removal and replacement of phrenic nerve stimulator, including
vessel catheterization, all imaging guidance, and interrogation and
programming, when performed; pulse generator
• 33288 -- ; transvenous stimulation or sensing lead(s)
– Replaces deleted 0424T-0433T
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Urinary/Genital Systems
• Additions – 2
• Revisions – ZERO
• Deletions – ZERO
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Urinary System
• 52284 – Cystourethroscopy, with mechanical urethral dilation and urethral
therapeutic drug delivery by drug-coated balloon catheter for urethral stricture
or stenosis, male, including fluoroscopy, when performed
– Replaces deleted 0499T
Urotronic.com
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Female Genital System
• 58580 – Transcervical ablation of uterine fibroid(s), including intraoperative
ultrasound guidance and monitoring, radiofrequency
– Replaces deleted 0404T
– For laparoscopic ablation of uterine fibroid(s) use 58674
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Nervous System
• Additions – 6
• Revisions – 4
• Deletions – ZERO
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Nervous System
• 61889 – Insertion of skull-mounted cranial neurostimulator pulse generator or
receiver, including craniectomy or craniotomy, when performed, with direct or
inductive coupling, with connection to depth and/or cortical strip electrode
array(s)
• 61891 – Revision of skull-mounted cranial neurostimulator pulse generator or
receiver with connection to depth and/or cortical strip electrode array(s)
• 61892 – Removal of skull-mounted cranial neurostimulator pulse generator or
receiver with cranioplasty, when performed
– Do not assign 61892 and 61891 for the same pulse generator
– https://www.youtube.com/watch?v=7j0oYybl5Js
Bioinduction.com
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Nervous System
• 63685 – Insertion or replacement of spinal neurostimulator pulse generator or
receiver, requiring pocket creation and connection between electrode
array and pulse generator/receiver
• 63688 – Revision or removal of implanted spinal neurostimulator pulse
generator/receiver, with detachable connection to the electrode array
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Nervous System
• 64596 – Insertion or replacement of percutaneous electrode array, peripheral
nerve, with integrated neurostimulator, including imaging guidance, when
performed; initial electrode array
• +64597 -- ; each additional electrode array
• 64598 – Revision/removal of neurostimulator electrode array, peripheral nerve,
with integrated neurostimulator
– For percutaneous implantation of electrode array ONLY, peripheral nerve 64555
Step 1 Step 2
Implantation of trial or permanent
electrode array(s) for field stimulation
(i.e., without a target nerve), use
64999
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Eye and Adnexa
• Additions – 1
• Revisions – ZERO
• Deletions – ZERO
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Eye and Adnexa
• 67516 – Suprachoroidal space injection of pharmacologic agent (separate
procedure)
– Replaces deleted 0465T
– Report medication separately (e.g. triamcinolone)
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Radiology
• Additions – 5
• Revisions – ZERO
• Deletions – 1
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Radiology
• 74710 – Pelvimetry, with or without placental localization
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Radiology
• 75580 – Noninvasive estimate of coronary fractional flow reserve (FFR) derived
from augmentative software analysis of the data set from a coronary computed
tomography angiography, with interpretation and report by a physician/QHCP
– If performed on same day as coronary CTA, report in conjunction with 75574
• 76984 – Ultrasound, intraoperative thoracic aorta (e.g. epiaortic), diagnostic
• 76987 – Intraoperative epicardial cardiac ultrasound (echo) for congenital
heart disease, diagnostic; including placement and manipulation of transducer,
image acquisition, interpretation and report
• 76988 -- ; placement, manipulation of transducer, and image acquisition only
• 76989 -- ; interpretation and report only
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Pathology
• Additions – 75 (including PLAs/MAAAs)
• Revisions – 25
• Deletions – 16
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Pathology
• Proprietary Lab Analyses
– MANY codes were added for PLAs related to:
• Oncology, infectious agents (gastrointestinal, surgical wounds, genitourinary), chronic
kidney disease, neurology (Parkinson disease), psychiatry (depression, anxiety, ADHD)
– PLA codes are released quarterly
• https://www.ama-assn.org/practice-management/cpt/cpt-pla-codes
– Appendix O contains a complete list
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Medicine
• Additions – 43
• Revisions – 12
• Deletions – ZERO
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Medicine
• 90380 – Respiratory syncytial virus, monoclonal antibody, seasonal dose;
0.5mL dosage, for IM use
• 90381 --; 1mL dosage for IM use
• 90670 – Respiratory syncytial virus vaccine, preF, recombinant, subunit,
adjuvanted, for IM use
• 90683 – Respiratory syncytial virus vaccine, mRNA lipid nanoparticles, for IM
use
– Note: pending FDA approval
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Medicine
• Changes made to COVID-19 Vaccine Codes
– FDA recommended shifts to monovalent vaccines that target the XBB lineage virus strain
for 2023-2024.
– New product codes for
• Pfizer ( 91318-91320) 60+ CPT codes down to only 7!!!!
• Moderna products ( 91321-91322)
– New administration code ( 90480) – Used for ANY COVID-19 vaccine for any patient
(pediatric or adult)
• Replaces all previously approved specific vaccine product and admin codes
• EXCEPTION! ( 91304) for the Novavax COVID-19 vaccine product
• Appendix Q is deleted (even though still printed in 2024 CPT manual)
• Reference AMA’s website for complete information: COVID-19 CPT coding and
guidance | COVID-19 test code | AMA (ama-assn.org)
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Did someone
say “chikun”?
Medicine
• 90589 – Chikungunya virus vaccine, live attenuated for IM use
• 90611 – Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, non-
replicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous
use
• 90622 – Vaccinia (smallpox) virus vaccine, live, lyophilized, 0/3 mL dosage, for
percutaneous use
• 90623 – Meningococcal pentavalent vaccine, conjugated Men A, C, W, Y-
tetanus toxoid carrier, and Men B-FHbp, for IM use
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Medicine
• 92622 – Diagnostic analysis, programming, and verification of an auditory
osseointegrated sound processor, any type; first 60 minutes
• +92623 – ; each additional 15 minutes
– Can also be used for subsequent reprogramming, when performed
• +92972 – Percutaneous transluminal coronary lithotripsy
– Can be reported separately with coronary PTCA, atherectomy, stenting, revascularizations,
thrombolysis (see parenthetical notes)
– Replaces deleted 0715T
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Medicine
• 93150 – Therapy activation of implanted phrenic nerve stimulator system,
including all interrogation and programming
– Typically performed about 30 days after insertion ( 33276)
• 93151 – Interrogation and programming (minimum one parameter) of implanted
phrenic nerve stimulator system
• 93152 – Interrogation and programming of implanted phrenic nerve stimulator
system during polysomnography
– Replaces deleted 0434T-0436T
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Medicine
• +93584 – Venography for congenital heart defect(s), including catheter
placement, and radiological S & I; anomalous or persistent superior vena cava
when it exists as a second contralateral superior vena cava, with native
drainage to heart
– First SVC (non-anomalous) is reported with 75827(Venography, caval, superior, radiological
S &I)
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Medicine
• +93585 --; azygos/hemiazygos venous system
• +93586 -- ; coronary sinus
• +93587 -- ; venovenous collaterals originating at or above the heart (from the
innominate vein)
• +93588 -- ; venovenous collaterals originating below the heart (from the IVC)
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Medicine
• +96547 – Intraoperative hyperthermic intraperitoneal chemotherapy procedure,
including separate incision(s) and closure, when performed; first 60 minutes
• + 96548 -- ; each additional 30 minutes
– “HIPEC”
• 96920-96922 – Excimer laser treatment for (psoriasis); <250-500+sqcm
– https://dermskinhealth.com/treatments/xtrac-excimer-laser/
• 97037 – Application of a modality to 1 or more areas; low-level laser therapy
(i.e., nonthermal and non-ablative) for post-operative pain reduction
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Medicine
• 97550 – Caregiver training in strategies and techniques to facilitate the
patient’s functional performance in the home or community (e.g., ADLs,
transfers, mobility, communication, feeding etc.), without the patient present,
face to face; initial 30 minutes
• +97551 --; each additional 15 minutes
• 97552 – Group caregiver training in strategies and techniques to facilitate the
patient’s functional performance in the home or community (e.g., ADLs,
transfers, mobility, communication, feeding etc.), without the patient present,
face to face with multiple sets of caregivers
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Category III
• Additions – 82
• Revisions – 13
• Deletions – 32
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Category III - Highlights
• 0656T – Anterior lumbar or thoracolumbar vertebral body tethering; up to 7
vertebral segments
• 0657T -- ; 8 or more segments
• 0790T – Revision, replacement or removal of thoracolumbar or lumbar
vertebral body tethering, including thoracoscopy, when performed
– New Cat I codes added for thoracic segments in 2024 – Matched verbiage used in those
codes
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Category III - Highlights
• 0827T- 0856T
– 31 new codes added for digitization of glass microscope slides (codes vary by specimen
type/study
– May be reported separately with Category I codes for the primary service
– Static digital images, digital video streaming of any portion of a glass microscope slide on
smartphone or tablet does not constitute a digital pathology digitization procedure.
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Conventional PM
Category III – Highlights
• 0795T – 0804T – Transcatheter
permanent dual-chamber leadless
pacemaker procedures (including
imaging guidance)
– Insertion
– Removal/replacement
– Programming Leadless PM
– 10 new codes
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Conventional PM
Category III – Highlights
• 0823T – 0826T – Transcatheter
permanent single-chamber RIGHT
ATRIAL leadless pacemaker
procedures (including imaging
guidance)
– Insertion
– Removal/replacement
Leadless PM
– Programming
– 4 new codes
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Questions?
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About This Resource
As part of your PROPEL membership, your team has regular education
sessions with our esteemed industry experts. Conducted through our
interactive virtual meeting platform, these training events provide insight
and the opportunity to ask questions on topics that are essential to your
work. View the recording of the session corresponding to this slide deck
on your team’s PROPELProfile (personal online membership hub).
Questions? Contact Michele Schweighoffer, your team’s dedicated
member liaison, at [email protected].
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