The CPT® 2022 edition incorporates a total of 249 novel codes, along with 93 codes that have been revised, and 63 codes that have been removed. Every segment of the CPT® code set has undergone modifications to codes and guidelines. The most substantial revisions are observed in evaluation and management (E/M) codes, spine-related procedures such as arthrodesis and laminectomies, cardiac catheterizations pertaining to congenital anomalies, laboratory and pathology codes, and codes for COVID-19 vaccinations.
Here, we provide a comprehensive summary of these alterations categorized by section.
Evaluation and Management
Within the CPT® 2022 update, revisions have been introduced to the code descriptor for 99211. The phrase “Usually, the presenting problem(s) are minimal” has been removed. This editorial adjustment aligns with the modifications made in 2021 to the office/other outpatient services, where the description of the presenting problem was excluded from all code descriptors ranging from 99202 to 99215.
Inclusion of new guidelines is notable for care management services, encompassing chronic care management (CCM), complex chronic care management (CCCM), and a fresh subsection dedicated to principal care management (PCM). The recently introduced PCM codes, denoted as 99424 to 99427, replace the HCPCS Level II codes established by the Centers for Medicare & Medicaid Services for these services in the preceding year (G2064 and G2065).
CCM and CCCM specifically involve the management of two or more conditions, resulting in an existing gap in coding options for cases where care management pertains to a single condition. The PCM codes are time-based and should be reported once during each calendar month. Codes 99424 and +99425 are applied based on time when these services are administered by a physician or another qualified healthcare professional (QHP). Similarly, codes 99426 and +99427 are reported based on time when executed by clinical staff.
Another noteworthy addition in CPT® 2022 is the introduction of a new table encompassing all care management codes. This table serves as a valuable aid to enhance coding precision. It provides details including the respective code, type of care management, the entity delivering the services, time considerations, and limitations on the number of units for each calendar month.
Anesthesia
CPT® 2022 brings about the elimination of codes 01935 and 01936, which are then replaced with novel codes offering a higher degree of detail. Emerging codes 01937 to 01942 are designed to specify both the surgical procedure requiring anesthesia and whether it’s carried out on the cervical or thoracic spine, as well as the lumbar or sacral spine.
Surgery: Integumentary System
The revision of insertion of drug delivery implant code 11981 in CPT® 2022 introduces clarity, stipulating that the procedure encompasses the insertion of bioresorbable, biodegradable, or non-biodegradable implants. This expansion reflects an update from the prior version, which solely mentioned non-biodegradable implants in the code descriptor.
Revised guidelines for simple repairs aim to offer clear insight into the work necessary to report these codes. These updated guidelines now specify that “Chemical cauterization, electrocauterization, or wound closure utilizing adhesive strips as the sole repair material are included in the appropriate E/M code.” This refinement effectively prevents the misreporting of simple repairs, which was a common coding error, especially when only electrocauterization was performed.
Surgery: Musculoskeletal System
Introductory guidelines within the musculoskeletal system section are revamped in CPT® 2022 to elucidate that procedures within this segment “include the application and removal of the first cast, splint, or traction device, when performed.” Subsequent cast or strapping codes should be reported when administered after the global period.
Revisions are also made to the fracture and dislocation guidelines, emphasizing that code selection hinges on the type of treatment and stabilization applied, rather than the type of fracture itself. Instances arise where a closed fracture necessitates open treatment.
The code for closed treatment of nasal bone fracture without manipulation (21310) is eliminated. Closed treatment codes 21315 and 21320 for nasal bone fractures are revised to encompass “with manipulation.” Code 21315 is applicable when manipulation is carried out without stabilization, while code 21320 pertains to procedures performed with stabilization.
Fresh guidelines and definitions are incorporated for posterior/posterolateral techniques in spine procedures. This addition aims to clarify any ambiguity surrounding the terminology used in certain spine codes and the circumstances under which specific procedures can be appropriately reported together. A textual change is made in codes 22600 to 22614, replacing “level” with “interspace.” This modification is also reflected in the parenthetical notes throughout this subsection. Additionally, definitions for terms such as corpectomy, facetectomy, foraminotomy, hemilaminectomy, laminectomy, and laminotomy are introduced. Codes 22633 and 22634 undergo revision, with the removal of “and segment.”
Surgery: Cardiovascular System
Within CPT® 2022, there are three fresh codes introduced to encompass the exclusion of the left atrial appendage, accompanied by newly included introductory guidelines and parenthetical explanations. These novel codes are not to be reported alongside maze procedures (33254-33259, 33265, 33266) or procedures related to mitral valve repair/replacement (33420, 33422, 33425-33427, 33430).
For the exclusion of the left atrial appendage performed via an open approach, Code 33267 is designated. Code +33268 pertains to the exclusion of the left atrial appendage through an open approach, specifically in scenarios involving another sternotomy or thoracotomy procedure. The performance of left atrial appendage exclusion using a thoracoscopic approach is captured by Code 33269. Code +33370 documents the insertion and subsequent removal of cerebral embolic protection devices. These devices find application in procedures like transcatheter aortic valve replacement (TAVR) and transcatheter aortic valve implantation (TAVI).
Additionally, Code 33509 outlines the endoscopic harvest of an upper extremity artery for coronary artery bypass procedures.
The realm of transcatheter interventions for revascularization or repair of coarctation of the aorta witnesses the introduction of three new codes: Code 33894 denotes stent placement across major side branches; code 33895 pertains to stent placement not spanning major side branches; and code 33897 is designated for situations where angioplasty is conducted without the application of a stent.
Surgery: Digestive System
CPT® 2022 introduces a novel code, 42975, to encompass drug-induced sleep endoscopy. This code delineates the examination of anatomic structures along with the evaluation of the effects stemming from positional adjustments and manipulations of the head and neck. This procedure is particularly relevant for conditions like obstructive sleep apnea.
The revised versions of gastroduodenal anastomosis with reconstruction codes, 43850 and 43855, are omitted from CPT® 2022 due to their infrequent utilization.
Surgery: Urinary System
The transition of Category III codes 0548T-0551T to newly established Category I codes 53451-53454 serves to document periurethral transperineal balloon continence device procedures:
- 1. Code 53451 pertains to the bilateral insertion of the continence device, inclusive of cystourethroscopy and imaging guidance.
- 2. Code 53452 captures the unilateral insertion of the continence device, along with cystourethroscopy and imaging guidance.
- 3. Code 53453 addresses the removal of the balloon in the continence device, with each removed balloon being separately reported.
- 4. Code 53454 characterizes the percutaneous adjustment of balloon(s) fluid volume. This code’s usage is incompatible with codes 53451 and 53452.
Surgery: Male Genital System
Revisions in this update alter codes for the repair of hypospadias complications (54340, 54344, 54348) by adding an “s” to “complication” within the code descriptor. This enhancement clarifies that the repair can encompass one or multiple complications. Additionally, Code 54352 is modified to indicate “revision of prior hypospadias repair.”
Surgery: Female Genital System
While this section witnesses minimal changes, it is important to acknowledge the removal of code 59135 from CPT® 2022 due to limited utilization.
Surgery: Nervous System
For the treatment of intracranial lesions using laser interstitial thermal therapy (LITT), two new codes, 61736 and 61737, are introduced.
Supplementary codes, +63052 and +63053, now account for laminectomy, facetectomy, or foraminotomy during a posterior interbody arthrodesis. These additional codes can be employed alongside codes 22630, 22632, 22633, and 22634. Notably, the code descriptors exclusively mention “lumbar” as this procedure is solely performed on the lumbar spine.
Deletion of low-utilization codes encompasses laminectomy codes 63194-63196, 63198, and 63199. Code 63197 undergoes a revision, assuming the role of a parent code, coupled with the removal of the former parent code 63196.
In the domain of neurostimulator electrode array implantation, codes 64575-64581 see modifications where “incision for” is replaced with “open.” Additionally, the addition of three new codes in 2022, namely 64582-64584, allows for the reporting of hypoglossal nerve stimulator array procedures. Code 64582 pertains to implantation, 64583 covers revisions or replacements, and 64584 corresponds to removal.
Surgery: Eye and Ocular Adnexa
CPT® 2022 introduces new codes 66989 and 66991 for the placement of anterior segment aqueous drainage devices within the trabecular meshwork, excluding the use of an external reservoir.
Surgery: Auditory System
Significant changes occur within osseointegrated implant procedures in CPT® 2022. This encompasses the deletion of codes 69715 and 69718, revisions to codes 69714 and 69717, and the creation of fresh codes 69716, 69719, 69726, and 69727.
- 1. Code 69716 pertains to the implantation of osseointegrated implants.
- 2. Code 69719 describes implant replacement involving removal.
- 3. Code 69726 outlines the removal of osseointegrated implants with percutaneous attachment to an external speech processor.
- 4. Code 69727 delineates the removal of osseointegrated implants with magnetic transcutaneous attachment to an external speech processor.
Radiology
Emerging codes 77089-77092 encompass the reporting of trabecular bone score (TBS). Code 77089 delineates the utilization of Dual-Energy X-ray Absorptiometry (DXA), incorporating calculation, interpretation, and fracture risk assessment. Code 77090 specifies technical preparation and data transmission. Code 77091 focuses solely on technical calculation. Lastly, code 77092 encompasses interpretation and fracture risk reporting, which is conducted by other Qualified Healthcare Professionals (QHPs).
Pathology and Laboratory
The pathology clinical consultation subsection undergoes revisions inclusive of new guidelines and a medical decision making (MDM) table. Codes 80500 and 80502 are eradicated, paving the way for new codes 80503-80506. These new codes serve to depict consultation complexity levels. Code 80503 encapsulates low MDM, 80504 represents moderate MDM, and 80505 signifies high MDM. Furthermore, an add-on code +80506 accounts for prolonged services.
CPT® 2022 also introduces numerous new proprietary laboratory analyses (PLA) codes. These codes elucidate PLAs furnished by a single laboratory or made accessible to multiple providing laboratories. This subsection includes multianalyte assays with algorithmic analyses (MAAA) and genomic sequencing procedures (GSP).
Medicine
Pertaining to COVID-19 vaccines, codes are introduced to address their administration, reflecting early usage due to the public health emergency. Vaccine administration codes encompass vaccine type and number of doses. Reporting COVID-19 vaccines entails both an administration code and a supply code (if the provider did not acquire the vaccine supply for free). Appendix Q offers coding clarification for the appropriate utilization of COVID-19 vaccine administration and supply codes.
The cardiac catheterization for congenital heart defects subsection undergoes revisions with new guidelines and the addition of codes 93593-93598:
- 1. Code 93593 describes right heart catheterization in patients with normal native connections.
- 2. Code 93594 covers right heart catheterization in patients with abnormal native connections.
- 3. Code 93595 pertains to left heart catheterization in patients with normal or abnormal native connections.
- 4. Code 93596 encapsulates both left and right heart catheterization in patients with normal native connections.
- 5. Code 93597 encompasses left and right heart catheterization in patients with abnormal native connections.
- An add-on code, +93598, characterizes cardiac output measurement.
- Codes 93530-93533 are discontinued in CPT® 2022.
