In the upcoming year, medical coders can anticipate a more streamlined process in adapting to the revised code set, which encompasses alterations in E/M codes and more. Notably, the CPT® Editorial Panel has sanctioned a smaller number of new codes for 2021, providing a welcomed respite. This is particularly relieving in light of the comprehensive coding and guideline adjustments slated for implementation on January 1, specifically for evaluation and management (E/M) services.
The modifications to CPT Code for 2021 encompass:
- 329 editorial changes
- 206 new codes
- 69 revised code descriptors
- 54 codes have been removed
As highlighted in a press release by the American Medical Association (AMA), “The CPT code set continues to expand into new and pioneering areas of medicine, with a substantial majority (63%) of new codes this year focusing on cutting-edge technology services outlined in Category III CPT codes. Additionally, there is ongoing growth in the Proprietary Laboratory Analyses (PLA) section of the CPT code set.
SARS-CoV-2 Related CPT Codes
Several new codes debuting in the 2021 CPT code set were implemented earlier this year because of the COVID-19 public health emergency (PHE). They include:
- CPT Code 87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique.Effective March 13, 2020.
- CPT Code 86328 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) to report single step antibody testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Effective April 10, 2020.
- CPT code 86769 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) to report multiple-step antibody testing for SARS-CoV-2. Effective April 10, 2020.
- CPT 0202U Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected to report the BioFire® Respiratory Panel 2.1 (RP2.1) proprietary laboratory analyses (PLA) tests. Effective May 20, 2020.
New Early-Release Codes
The mid-year code additions aren’t over yet, though. The CPT® 2021 code set includes two new codes that are effective Oct. 1, 2020:
- CPT Code 0015M Adrenal cortical tumor, biochemical assay of 25 steroid markers, utilizing 24-hour urine specimen and clinical parameters, prognostic algorithm reported as a clinical risk and integrated clinical steroid risk for adrenal cortical carcinoma, adenoma, or other adrenal malignancy
- CPT Code 0016M Oncology (bladder), mRNA, microarray gene expression profiling of 209 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as molecular subtype (luminal, luminal infiltrated, basal, basal claudin-low, neuroendocrine-like)
2021 CPT Code Changes
As the AMA points out in their press release, CPT® 2021 includes several new Category I codes in the Pathology and Laboratory and Medicine sections. There are also many new Category III codes, including those for computed tomography of the breast including 3D rendering.
As promised, CPT® 2021 includes many revised E/M codes and 99201 is deleted.
| CPT Code 99202 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter. |
| CPT Code 99203 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter. |
| CPT Code 99204 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter. |
| CPT Code 99205 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter. |
| CPT Code 99211 | Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. |
| CPT Code 99212 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter. |
| CPT Code 99213 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter. |
| CPT Code 99214 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter. |
| CPT Code 99215 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter. |
| CPT Code 99354 | Prolonged service(s) in the outpatient setting requiring direct patient contact beyond the time of the usual service; first hour (List separately in addition to code for outpatient Evaluation and Management or psychotherapy service, except with office or other outpatient services [99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215]) |
| CPT Code 99355 | Prolonged service(s) in the outpatient setting requiring direct patient contact beyond the time of the usual service; each additional 30 minutes (List separately in addition to code for prolonged service) |
| CPT Code 99356 | Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient or observation Evaluation and Management service) |
| CPT Code 99415 | Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service) |
| CPT Code 99416 | Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; each additional 30 minutes (List separately in addition to code for prolonged service) |
| CPT Code 99487 | Complex chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised, or monitored, moderate or high complexity medical decision making; first 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month. |
| CPT Code 99489 | Complex chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised, or monitored, moderate or high complexity medical decision making; each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure) |
| CPT Code 99490 | Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised, or monitored; first 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month. |
Although there are not a record number of new codes, there are changes to CPT® 2021 in nearly every section. Correct coding will rely on having the most up-to-date coding resources and paying particular attention to guideline revisions.
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