2024 Update CPT: New Changes in Coding Guidelines

Please review the latest updates on CPT coding and guidelines for professional services.

Every year on January 1st, new CPT® codes and coding guidelines are released that include new, revised, and eliminated codes. CPT® 2024 introduces 230 new codes, 70 revised codes, and 49 removed codes. However, there are no changes made to anesthesia, integumentary, digestive, male genital, or auditory systems. The most significant changes are seen in evaluation and management (E/M) services, the phrenic nerve stimulation system, lab and pathology, COVID-19 and RSV vaccinations, and Category III codes. Below is a detailed breakdown of the changes made in each section.

Evaluation and Management

Revised E/M codes have been introduced for office and other outpatient visits, with the aim of bringing their language in line with other E/M codes. The changes remove specific time ranges from the code descriptors, for example, the descriptor for 99213 now states that “…20 minutes must be met or exceeded”. It is important to note that these editorial changes do not alter the time associated with each code.

In addition, E/M guidelines now cover split/shared visits. CPT® specifies that the significant part of the encounter involving medical decision-making (MDM) necessitates physician(s) or other Qualified Healthcare Provider(s) (QHP) involvement in creating or approving the management plan for the complexity of problems addressed during the encounter. This involvement holds the responsibility for the plan, encompassing the inherent risks of complications and/or patient management’s morbidity or mortality. This means that a physician or other QHP fulfills two of the three elements used in selecting the code level based on MDM.

The guidelines also address data, constituting the third element of E/M. If code selection relies on time, the provider who predominantly spent the time during a split/shared visit should report the service.

Furthermore, additional guidelines have been included to clarify reporting multiple E/M services on the same date, such as hospital inpatient and observation care or nursing facility visits, which are considered “per day” services. When a patient sees the same specialty provider multiple times within the same day and setting within the same group practice, a single E/M code is used. A thorough review of the detailed E/M guidelines is crucial for accurate E/M coding.

Moreover, within this section, revisions have been made to two nursing facility codes: 99306 now specifies 50 minutes instead of 45 minutes, and 99308 denotes 20 minutes instead of 15 minutes.

Many of the E&M codes have been updated with new times and a clear explanation of how to use them. The previous ranges have been replaced with a specific time that should be met or exceeded. Additionally, a few “G” codes have been introduced for principal illness navigator, SDOH risk assessment, and community health integration (SDOH). It’s important to note that there were 553 changes and updates to HCPCS Level II codes that coders should be aware of.

Surgery: Musculoskeletal System

CPT® 2024 introduces three new codes for anterior thoracic vertebral body tethering, an alternative to spinal fusion surgery. This procedure allows for ongoing spinal growth and flexibility and is mainly performed on scoliosis patients. The introductory guidelines and accompanying instructions for these codes are as follows:

– Code 22836 refers to anterior thoracic vertebral body tethering for up to seven vertebral segments.

– Code 22837 addresses anterior thoracic vertebral body tethering for eight or more vertebral segments.

– Code 22838 relates to the revision, replacement, or removal of thoracic vertebral body tethering.

In addition, a new code, 27278, has been added to document sacroiliac joint arthrodesis. This code specifically denotes the placement of an intra-articular stabilization device through a minimally invasive technique that doesn’t penetrate the joint.

The codes within the hallux valgus correction family (28292-28299) have undergone revisions, eliminating the inclusion of bunionectomy within parentheses and providing clarification that the procedure specifically involves “with bunionectomy.”

Surgery: Respiratory System

It has been announced that two new codes have been created to record the damage caused to the posterior nasal nerve during a nasal or sinus endoscopy. One of the codes, 31242, is intended to denote the procedure performed using radiofrequency ablation. The other code, 31243, is to be used for the procedure carried out with cryoablation.

Surgery: Cardiovascular System

CPT® 2024 introduces eight new codes for the phrenic nerve stimulation system, with accompanying guidelines and guidance. The new codes are listed below:

• 33276 covers the insertion of the pulse generator and stimulating leads, along with the initial analysis of the generator involving diagnostic mode activation.
  • +33277, an add-on code, denotes the insertion of the transvenous sensing lead.
  • 33278 is designated for the removal of both the pulse generator and lead(s).
  • 33279 specifically relates to the removal of only the leads.
  • 33280 addresses the removal of solely the pacemaker.
  • 33281 pertains to the repositioning of the lead(s).
  • 33287 is allocated for the removal and replacement of the pulse generator.
  • 33288 is dedicated to the removal and replacement of the lead(s).

The manual contains eight new phrenic nerve stimulator codes (33276-33281 and 33287-33288), which will replace 12 T codes (0424T-0436T).

Several changes were made to the introduction notes for pacemaker insertions. Ten new Category III codes were added for different procedures related to the insertion, revision, and removal of components of LEADLESS DUAL CHAMBER pacemakers. These pacemakers consist of a combined generator and electrode device that is inserted into the heart chambers.

Additionally, four new category III codes were added for procedures related to RIGH ATRIAL LEADLESS pacemaker insertion. Category III codes were also added for the removal and relocation of two types of components of the wireless cardiac stimulation system for left ventricular pacing.

Furthermore, five codes were added to the medicine section for venography for congenital defects by vein location. Two new Category III codes were added for percutaneous and open insertion of SVC/IVC valves, which are used for the treatment of tricuspid regurgitation.

Lastly, category code 0793T was added to treat pulmonary hypertension through the transcatheter thermal ablation of nerves innervating pulmonary arteries.

Surgery: Urinary System

The code 52284 that has been recently added pertains to a medical procedure called cystourethroscopy. This procedure involves the use of a mechanical urethral dilation and a drug-coated balloon catheter for the treatment of urethral stricture or stenosis in male patients. The procedure employs fluoroscopy to address these specific conditions. cystourethroscopy code 52284 will replace 0499T.

Surgery: Female Genital System

A new code 58580 has been introduced for transcervical radiofrequency ablation of uterine fibroids. The procedure is performed with intraoperative ultrasound guidance and monitoring.

Surgery: Nervous System

There are new codes for procedures involving skull-mounted cranial pulse generators or receiver devices. The first code, 61889, is for insertion, the second code, 61891, is for revision or replacement, and the third code, 61892, is for removal.

The code for the insertion or replacement of a spinal neurostimulator pulse generator or receiver, 63685, has been revised. This code now requires the creation of a pocket and the establishment of a connection between the array and the pulse generator or receiver.

The revision for the implanted spinal neurostimulator code, 63688, now includes a “detachable connection to the electrode array.”

Code 64590 has been updated to include “sacral” specifications. It highlights the need for pocket creation and connection between the electrode array and pulse generator or receiver. Correspondingly, code 64595 now includes “sacral” and specifies the procedure with a detachable connection to the electrode array.

Furthermore, a new code, 64596, has been introduced. This code is for the insertion or replacement of the initial electrode array for the percutaneous electrode array of a peripheral nerve with an integrated neurostimulator. An add-on code, +64597, accompanies 64596 for reporting each additional electrode array.

Lastly, a new code, 64598, describes the revision or removal of the neurostimulator electrode array with an integrated neurostimulator of a peripheral nerve.

Surgery: Eye and Ocular Adnexa

The administration of a pharmacologic agent into the suprachoroidal space is outlined in code 67516, with the medication reported separately. A new category code, 0810T, was created for subretinal injection of a pharmacological agent that includes vitrectomy and one or more retinotomies.

Radiology

The following CPT codes have been updated:

– The previous code for pelvimetry 74710 has been removed. It has been replaced with a new code 75580 which characterizes a non-invasive estimation of coronary fractional flow reserve (FFR). This new code is derived from software analysis that augments the data set obtained from a coronary computed tomography angiography.

– A new CPT code 76984 has been introduced to define a diagnostic intraoperative thoracic aorta ultrasound.

In addition, three new CPT codes have been added for epicardial ultrasound concerning congenital heart disease. Here are the details:

– If all facets of the procedure are conducted, including transducer placement, manipulation, image acquisition, interpretation, and reporting, the use of the new CPT code 76987 is recommended.

– If the provider only undertakes transducer placement, manipulation, and image acquisition, CPT code 76988 should be used.

– Similarly, if the provider exclusively performs the interpretation and reporting, CPT code 76989 is applicable.

Pathology and Laboratory

This section has undergone several changes and additions. CPT Codes 81171, 81172, 81243, 81244, 81403, 81404, 81405, 81406, and 81407 have been revised to replace the term “mental retardation” with “intellectual disability.” Additionally, six new genomic sequence analysis panel codes have been introduced for solid organ neoplasms.

• 81457: DNA analysis for sequence variants and microsatellite instability.
  • 81458: DNA analysis for sequence variants, copy number variants, and microsatellite instability.
  • 81459: DNA or combined DNA and RNA analysis for sequence variants, copy number variants, microsatellite instability, tumor mutation burden, and rearrangements.
  • 81462: DNA or combined DNA and RNA analysis from cell-free nucleic acid for sequence variants, copy number variants, and rearrangements.
  • 81463: DNA analysis for sequence variants, copy number variants, and microsatellite instability from cell-free nucleic acid.
  • 81464: DNA or combined DNA and RNA analysis from cell-free nucleic acid for sequence variants, copy number variants, microsatellite instability, tumor mutation burden, and rearrangements.

There are some recent updates in the medical codes. A new code 81517 has been introduced for liver fibrosis and liver-related clinical events that occur within five years. This code is for a multianalyte assay with algorithmic analyses (RMA). Another new code 82166 is for the chemistry test used to check for anti-Müllerian hormone (AMH). Additionally, three new immunology codes have been introduced for acetylcholine receptors (AChR).

86041: Includes binding antibody.
86042: Includes blocking antibody.
86043: Includes modulating antibody.

A few new codes have been created for testing different diseases. The first one, called 86366, is for testing muscle-specific kinase (MuSK) antibodies. The second code, named 87523, is for testing hepatitis D, while the third one, 87593, is for orthopoxvirus testing. Orthopoxvirus testing includes testing for viruses such as monkeypox virus, cowpox virus, and vaccinia virus.

In addition, there are several new codes for proprietary laboratory analyses (PLA). These codes describe tests that are offered by a single laboratory or licensed for use by multiple laboratories. These tests include MAAA and genomic sequencing procedures (GSP).

Medicine

Two new codes have been introduced for the immune globulins subsection of the medicine section, specifically for respiratory syncytial virus (RSV). These codes, numbered 90380 and 90381, relate to the monoclonal antibody used in a seasonal dose, with selection based on the dose: 0.5 mL and 1 mL, respectively.

There have been several changes to COVID-19 vaccine codes; however, these updates are not present in the CPT® 2024 code book due to changes made after printing. A new vaccination administration code, numbered 90480, now exists to report administering any COVID-19 vaccine for any patient, replacing all previously established specific vaccine administration codes. This new administration code includes counseling.

Distinct product codes for Pfizer and Moderna vaccines have been introduced for different age groups. Pfizer codes 91318, 91319, and 91320 are designated for patients aged 6 months through 4 years, 5 through 11 years, and 12 years and older, respectively. Correspondingly, Moderna codes 91321 and 91322 are specified for patients aged 6 months through 11 years and 12 years and older.

These new codes took effect on September 11, 2023. As a result, all previously approved COVID-19 vaccine supply and administration codes will be eliminated from the CPT® code set starting November 1, 2023. Detailed information on these changes can be found on the AMA website and the AAPC blog. They are also addressed in the CPT® Assistant Erratum for Special Edition: August Update, which can be accessed through the AMA website.

In addition, two new vaccine supply codes have been established for RSV: 90679 for reF, subunit, and bivalent, and 90683 for preF, recombinant, subunit, and adjuvanted, both intended for intramuscular use.

Four new codes have been introduced for the phrenic nerve stimulation system: 93150 for therapy activation, 93151 for interrogation and programming, 93152 for interrogation and programming during polysomnography, and 93153 for interrogation only, excluding programming.

Furthermore, five new add-on codes have been created for venography related to congenital heart defects. These codes encompass catheter placement and radiological supervision and interpretation. They are delineated as follows: +93584 for anomalous or persistent superior vena cava, +93585 for azygos/hemiazygos venous system, +93586 for the coronary sinus, +93587 for venovenous collaterals originating at or above the heart, and +93588 for venovenous collaterals originating below the heart.

Finally, three new codes (97550-97552) have been introduced for caregiver training.

Category III Codes

Numerous new Category III codes have been introduced to showcase innovative and emerging technologies. Some of these codes include add-on codes +0827T through +0856T for digital pathology digitization procedures, codes 0795T through 0804T for dual-chamber leadless pacemakers, and codes 0820T, +0821T, and +0822T for continuous monitoring and intervention during psychedelic medication therapy.

Explore Additional Modifications

Please take note of the following text: “CPT code changes chapter-wise” for CY2024.

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