Master CPT® 2022 Coding With This Expert Overview

December 2, 2021  by  Allzone MS   376

master-2022-cpt-changes-with-this-expert-overview

AAPC Senior VP of Products Raemarie Jimenez gives you the scoop on the code changes for next year.

CPT® 2022 includes 249 new codes, 93 revised codes, and 63 deleted codes. All sections of CPT® received changes in codes and guidelines. The most significant changes are to evaluation and management (E/M), arthrodesis and laminectomies of the spine, cardiac catheterizations for congenital anomalies, lab and pathology, and COVID-19 vaccinations. Here is an overview of the changes by section.

Evaluation and Management

In CPT®2022, the code descriptor for 99211 is revised to remove “Usually, the presenting problem(s) are minimal.” This editorial revision was made to be consistent with the changes to the office/other outpatient services in 2021, where the nature of the presenting problem was removed from all the code descriptors for 99202-99215 in 2021.

New guidelines are added for care management services, including chronic care management (CCM), complex chronic care management (CCCM), and a new subsection for principal care management (PCM). New PCM codes 99424-99427 replace the HCPCS Level II codes that the Centers for Medicare & Medicaid Services created for these services last year (G2064 and G2065).

CCM and CCCM require the care of two or more conditions. This left a gap in coding options when care management is performed for a single condition. The PCM codes are time-based and are reported once per calendar month. Codes 99424 and +99425 are reported based on time when the services are performed by a physician or other qualified healthcare professional (QHP). Codes 99426 and +99427 are also reported based on time when performed by clinical staff.

Also in CPT® 2022, there is a new table for all care management codes to assist in coding accuracy. The table includes the code, type of care management, who performed the services, time, and limitations on units for each calendar month.

Anesthesia

Codes 01935 and 01936 are deleted in CPT®2022 and replaced with new codes that provide more granularity. New codes 01937-01942 identify the type of surgical procedure for which anesthesia is being performed and whether the procedure is performed on the cervical or thoracic spine or the lumbar or sacral spine.

Surgery: Integumentary System

Insertion of drug delivery implant code 11981 is revised in CPT® 2022 to clarify that the procedure includes insertion of bioresorbable, biodegradable, or non-biodegradable implants — not just non-biodegradable implants, as stated prior to the revision of the code descriptor.

The guidelines for simple repairs are revised to clarify the work required to report these codes. The revised guidelines for simple repairs state, “Chemical cauterization, electrocauterization, or wound closure utilizing adhesive strips as the sole repair material are included in the appropriate E/M code.” This clarification will prevent the improper reporting of simple repairs when only electrocauterization is performed, which is a common coding error.

Surgery: Musculoskeletal System

The introductory guidelines for the musculoskeletal system are revised in CPT® 2022 to clarify that procedures in this section “include the application and removal of the first cast, splint, or traction device, when performed.” Report subsequent cast or strapping codes when performed after the global period.

Fracture and dislocation guidelines are revised to indicate that the codes are structured to be selected based on the type of treatment and type of stabilization, not the type of fracture. There are instances when a closed fracture will require open treatment.

The code for closed treatment of nasal bone fracture without manipulation (21310) is deleted. Closed treatment of nasal bone fracture codes 21315 and 21320 are revised to include “with manipulation.” Code 21315 is reported when manipulation is performed without stabilization. Code 21320 is reported when the procedure is performed with stabilization.

New guidelines and definitions are added to the posterior/posterolateral techniques for spine procedures in this code update. There has been confusion over the years regarding the terminology used in some of the spine codes and when certain procedures can be reported together. Codes 22600-22614 are revised to change “level” to “interspace.” In addition to the code descriptors, this editorial change is made in the parenthetical notes throughout this subsection. Definitions are added for corpectomy, facetectomy, foraminotomy, hemilaminectomy, laminectomy, and laminotomy. Codes 22633 and 22634 are revised to remove “and segment.”

Surgery: Cardiovascular System

CPT® 2022 includes three new codes for exclusion of left atrial appendage. Introductory guidelines and parentheticals are also added. The new codes cannot be reported with maze procedures (33254-33259, 33265, 33266) or mitral valve repair/replacement procedures (33420, 33422, 33425-33427, 33430).

Code 33267 is for exclusion of left atrial appendage when performed by an open approach.

Code +33268 is for exclusion of the left atrial appendage when performed by an open approach at the time of another sternotomy or thoracotomy procedure.

Code 33269 is for exclusion of the left atrial appendage when performed by a thoracoscopic approach.

Code +33370 reports the placement and removal of cerebral embolic protection devices. These devices are used in transcatheter aortic valve replacement (TAVR) and transcatheter aortic valve implantation (TAVI) procedures.

Code 33509 reports the endoscopic harvest of upper extremity artery for coronary artery bypass procedure.

Three new codes are added for transcatheter interventions for revascularization or repair of coarctation of the aorta: Code 33894 describes stent placement across major side branches; code 33895 describes stent placement that is not across major side branches; and code 33897 describes when angioplasty is performed without stent placement.

Surgery: Digestive System

A new code in CPT®2022 for drug-induced sleep endoscopy, 42975, describes the inspection of the anatomic structures and the effects of positional and head and neck manipulation for conditions like obstructive sleep apnea.

Revision of gastroduodenal anastomosis with reconstruction codes 43850 and 43855 are deleted due to low utilization.

Surgery: Urinary System

Category III codes 0548T-0551T are converted to new Category I codes 53451-53454 to report periurethral transperineal balloon continence device procedures:

Code 53451 describes bilateral insertion of the continence device. The procedure includes cystourethroscopy and imaging guidance.

Code 53452 describes unilateral insertion of the continence device. The procedure includes cystourethroscopy and imaging guidance.

Code 53453 describes the removal of the balloon of the continence device. The code is reported for each balloon removed.

Code 53454 describes the percutaneous adjustment of balloon(s) fluid volume. This code cannot be reported with 53451-53452.

Surgery: Male Genital System

Codes for the repair of hypospadias complication (54340, 54344, 54348) are revised in this code update to add “s” to “complication” in the code descriptor to clarify that one or more complications may be repaired. Code 54352 is revised to indicate “revision of prior hypospadias repair.”

Surgery: Female Genital System

Not a lot of action in this section, but it’s important to note that code 59135 is deleted due in CPT®2022 due to low utilization.

Surgery: Nervous System

Laser interstitial thermal therapy (LITT) for treatment of intracranial lesions is reported with two new codes, 61736 and 61737.

Two new add-on codes, +63052 and +63053, report laminectomy, facetectomy, or foraminotomy during a posterior interbody arthrodesis. These add-on codes can be reported with 22630, 22632, 22633, and 22634. You’ll notice in the code descriptor that only “lumbar” is included because this procedure is only performed on the lumbar spine.

Laminectomy codes 63194-63196, 63198, and 63199 are deleted due to low utilization. Code 63197 is revised to become a parent code, with the deletion of former parent code 63196.

Implantation of neurostimulator electrode array codes 64575-64581 are revised to change “incision for” to “open.” You’ll report hypoglossal nerve stimulator array procedures with three new codes in 2022: 64582-64584. Code 64582 describes the implantation. Code 64583 is reported for the revision or replacement. Removal is reported with 64584.

Surgery: Eye and Ocular Adnexa

Placement of anterior segment aqueous drainage device into the trabecular meshwork without external reservoir is reported with new codes 66989 and 66991 in this code update.

Surgery: Auditory System

The osseointegrated implant procedures went through a number of changes in CPT®2022, including the deletion of codes 69715 and 69718; revision of codes 69714 and 69717; and the creation of new codes 69716, 69719, 69726, and 69727.

Code 69716 describes the implantation of the osseointegrated implant.

Code 69719 describes the replacement including removal of the implant.

Code 69726 describes the removal of the osseointegrated implant with percutaneous attachment to an external speech processor.

Code 69727 describes the removal of the osseointegrated implant with magnetic transcutaneous attachment to an external speech processor.

Radiology

Trabecular bone score (TBS) is reported with new codes 77089-77092. Code 77089 describes the use of Dual-Energy X-ray Absorptiometry (DXA) and includes the calculation and interpretation and report on fracture risk. Code 77090 describes the technical preparation and transmitting the data. Code 77091 describes the technical calculation only. Code 77092 describes the interpretation and report on fracture risk only by other QHP.

Pathology and Laboratory

The pathology clinical consultation subsection includes new guidelines and a medical decision making (MDM) table. Codes 80500 and 80502 are deleted. New codes 80503-80506 are created to report the consultation based on the level of complexity. Code 80503 describes low MDM. Code 80504 describes moderate MDM. Code 80505 describes high MDM. Add-on code +80506 describes prolonged services.

There are also many new proprietary laboratory analyses (PLA) codes in CPT®2022. These codes describe PLAs provided by either a single laboratory or licensed/marketed to multiple providing laboratories. This subsection includes multianalyte assays with algorithmic analyses (MAAA) and genomic sequencing procedures (GSP).

Medicine

Codes for COVID-19 vaccines are released for early use based on the public health emergency. The vaccine administration codes include the type of vaccine and the number of doses. To properly report COVID-19 vaccines, there is an administration code and a supply code (if your provider did not receive the supply of the vaccine for free). Appendix Q is added for coding clarification on proper use of the COVID-19 vaccine administration and supply codes.

The cardiac catheterization for congenital heart defects subsection has new guidelines and new codes 93593-93598:

Code 93593 describes a right heart catheterization on a patient with normal native connections.

Code 93594 describes a right heart catheterization on a patient with abnormal native connections.

Code 93595 describes a left heart catheterization on a patient with normal or abnormal native connections.

Code 93596 describes a left and right heart catheterization on a patient with normal native connections.

Code 93597 describes a left and right heart catheterization on a patient with abnormal native connections.

Add-on code +93598 describes cardiac output measures.

Codes 93530-93533 are deleted in CPT®2022.

For More Information: https://www.aapc.com/blog/82724-master-2022-cpt-changes-with-this-expert-overview/