Aside from the highly discussed 2021 Evaluation and Management changes that are set to take effect on January 1, 2021, we find the CPT® code set continues to see growth in new and novel areas of medicine. Read below to find out more about these changes.
CPT® has recently updated their data file to contain 329 editorial changes; including 206 new codes, 54 deletions, and 69 revisions. A majority (63%) of new codes involve new technology services described in Category III codes and the continued expansion of the Proprietary Laboratory Analyses (PLA) section.
Although there are not a record number of new codes, it is evident there are changes to CPT® 2021 in nearly every section. As we start to read through the 2021 CPT® text, you see that illustrations have been updated, allowing users to have a better anatomical understanding. With the notable green text indicated throughout the new codebook, you will find many guidelines and instructions that have also been updated. Correct coding will rely on having the most up‐to‐date coding resources and paying particular attention to these important guideline revisions. The following paragraphs summarize some of the exciting updates headed this way!
The Introduction section starts with clarifying details about the release of CPT codes and provides a new CPT Code Set Update Calendar table. Several links referencing AMA resources on specific updates are also included.
The Evaluation and Management (E/M) section reveals a significant overhaul for the office visit and other outpatient services codes (99202 – 99215). This section provides entirely new guidelines and instructions for documenting and reporting these frequently used services, including definitions of commonly used terms. A new prolonged services code +99417 provides opportunity for clinicians to capture additional encounter time when appropriate.
Additional instructions clarify when reporting a preventive visit and an illness encounter on the same date of service should be considered.
Care Management Services, Chronic Care Management and the Behavioral Health Integration Care Management section all have new clarifying guidelines to help understand the type of work that should be performed and documented to report these unique services.
The Surgery section starts with updates to instructions in the Integumentary Section for Repairs and/or Reconstruction.
You will find new instructional guidelines and three new codes (33741,33745, +33746) for shunting procedures in the Cardiovascular System section.
The updates in the Medicine section illustrate how the CPT code set continues to be modified to respond to how fast‐paced innovative digital services can improve access to health care and improved health outcomes for patients. A great example of this is the addition of code 92229 for retinal imaging with automated point‐of‐care, and the revision to the descriptions of codes 92227 and 92228.
Codes 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248 have been also updated along with associated guideline revisions. These codes replace Category III codes 0295T, 0296T, 0297T and 0298T, which were deleted. These new codes utilize an innovative algorithmic technology that works in collaboration with a patch that is easier to wear for patients and provides more accurate and complete data for clinician interpretation.
Don’t miss the updated guidelines in the Dialysis section, if that is a service that impacts your organization.
A quick glance at Appendix C reveals significant changes to the Clinical Examples used to assist clinicians in understanding the meaning of the descriptors and selecting the right code. It is important to notice that each example in the text was developed by physicians in the specialties shown. Clinical examples of Office visit services have been removed from the 2021 edition as the CPT Editorial Panel continues to monitor and update these new services.
SARS‐CoV‐2 related CPT codes:
- Code 86318, effective April 10, 2020, is used to report immunoassay for infectious agent antibody(ies) and to be a parent to 86328; addition of code 86328 to report single step antibody testing for severe acute respiratory syndrome coronavirus 2; addition of child code 86769 to report multiple‐step antibody testing for severe acute respiratory syndrome coronavirus 2; and revision of the Immunology guidelines.
- PLA code 0202U, effective May 20, 2020, is used to report the BioFire® Respiratory Panel 2.1 (RP2.1) test.
- Code 87426 is used to report infectious agent antigen detection by immunoassay technique of SARS‐CoV and SARS‐CoV‐2.
- PLA codes (0223U and 0224U) were accepted for detection of SARS‐CoV‐2. ∙ Codes 86408 for reporting coronavirus 2 (SARS‐CoV‐2) neutralizing antibody screen and 86409 for reporting coronavirus 2 (SARS‐CoV‐2) neutralizing antibody titer were effective Aug. 10, 2020.
- PLA codes (0225U and 0226U) were accepted for detection of SARS‐CoV‐2. ∙ Code 99072, effective September 8, 2020, is used for additional supplies and clinical staff time required to mitigate transmission of respiratory infectious disease while providing evaluation, treatment, or procedural services during a public health emergency, as defined by law.
- Code, 86413, was created for reporting quantitative antibody detection of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2).
According to the AMA, the substantive need created by the unique circumstances of the SARS‐CoV‐2 pandemic provides justification to create specific codes to designate certain respiratory viral panels and expand upon code 87631:
- Code 87635, effective March 13, 2020, is used to report 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.
- Code 87636 for reporting combined respiratory virus multiplex testing for either SARS‐CoV‐ 2 with Influenza A&B and code 87637 for combined respiratory virus multiplex testing for either SARS‐CoV‐2 with Influenza A&B and RSV and 87811 for antigen detection of SARS‐ CoV‐2 by direct optical (i.e., visual) observation was added October 6, 2020.
- Two new PLA codes (0240U and 0241U) were accepted for detection of SARS‐CoV‐2, Influenza A and Influenza B; code 0240U also detects RSV. Additionally, Microbiology, Immunology guidelines were also revised, along with codes 87301, 87802 and their subsidiary codes.
- Per AMA: Please note that, per the standard early release delivery process for CPT codes, you will need to manually upload these code descriptors into your EHR system. Most of these CPT codes will arrive as part of the complete CPT code set in the data file for 2021 later this year. However, as updates are released further into CY 2020, please ensure your systems are updated with the COVID‐19‐related code releases on this page.
Review and download the full CPT code descriptor release: Category I/Pathology and Laboratory
- Coronavirus (SARS‐CoV‐2): Long descriptors (PDF)
- Coronavirus (SARS‐CoV‐2): Medium descriptors (PDF)
- Coronavirus (SARS‐CoV‐2): Short descriptors (PDF)
CPT Assistant fact sheets for coding guidance for new SARS‐CoV‐2 (COVID‐19)‐related testing codes can be found in the following links. These fact sheets include the following information:
- Codes, descriptors and purpose
- Clinical examples
- Description of the procedures
Download the Oct. 6, 2020 CPT Assistant guide (PDF, codes 87636, 87637, 0240U, 0241U)
Download the Sept. 8, 2020 CPT Assistant guide (PDF, information on code 99072)
Download the Aug. 10, 2020 CPT Assistant guide (PDF)
Download the June 25, 2020 CPT Assistant guide (PDF, information on code 87301)
Download the May 20, 2020 CPT Assistant guide (PDF)
Download the April 10, 2020 CPT Assistant guide (PDF, codes 86602, 86635)
Download the March 13, 2020 CPT Assistant guide (codes 87631, 87632, 87633, 0098U, 0099U, 0100U)
AMA Coding Advice and Testing Scenarios can be found on the following links:
Quick reference flow chart for CPT reporting for COVID‐19 testing (PDF)
Coding scenarios and how to apply best coding practices (PDF)