2023 has brought significant CPT code changes with 225 new codes 93 revised codes and 75 deleted codes. Additionally, there are coding guideline changes in every section except for anesthesia. While the primary and most impactful changes are to the Evaluation and Management (E/M) code section, the other sections with the most significant changes include percutaneous pulmonary artery revascularization, hernia repairs, lab/pathology and Covid-19 vaccination codes. In addition to code changes there are also new appendices that have been added including Appendix S; Artificial Intelligence (AI) Taxonomy and Appendix T; Synchronous Real-time Interactive Audio-only Telemedicine Services.

Please feel free to reach out to Ms. Sheila Haynes at shaynes@rtwelter.com if your practice needs additional assistance with coding, billing and documentation related questions or concerns.

  1. An overview of the CPT E/M changes
    • The level of E/M services will be based on the following:
      • The level of the MDM as defined for each service OR
      • The total time for the E/M service performed on the date of the encounter
        • Time spent by the practitioner includes face-to-face and non-face-to-face time
    • The History, Review of Systems, Personal/Family/Social information, and Exam elements will no longer be used to select the level of code.
    • There are revisions and combining of Hospital Inpatient and Observation Care Services E/M codes 99221-99223, 99231-99239 with revised guidelines (one code combines both services)
      • The Hospital Observation Service E/M codes have been deleted
      • The Inpatient Hospital Services E/M code descriptions have been revised to include Observation Care Services
    • Emergency department encounters (99281-99285) are reported based on medical decision making (MD) only. The total time rule doesn’t apply in the ED setting. Additionally, the definition for 99281 has been revised to state the encounter “may not require the presence of a physician or other qualified healthcare professional”. 99281 is now comparable to the 99211 “nursing visit” in the office and outpatient setting.
    • Nursing Facility code changes have also been established. 99318 the Annual Nursing Facility Assessment service code has been deleted. This will now be captured using the Subsequent Nursing Facility care codes (99307-99310) or the appropriate Medicare G-codes. There are also new/revised guidelines for the Nursing Facility Care code section
    • Changes to the Prolonged Services Codes
    • Centers for Medicare and Medicaid Services (CMS) proposed Prolonged Services Codes
  2. CMS 2023 Medicare Revisions
    • CMS has adopted most of the CPT revisions
    • However, CMS does not agree with the AMA regarding the use of Prolonged Service Codes
      • With the AMA: CPT codes 99358, 99359, 99415, and 99416 have new guidelines, 99417 has been revised and 99418 is the new AMA Prolonged hospital inpatient or observation care E/M code.
      • Instead, CMS is proposing its own prolonged service codes:
        1. G0316 for use with initial IP/Observation visits, Subsequent IP/Observation visits or IP/Observation same-day admit/discharge visit
        2. G0317 for use with initial and subsequent NF visits
        3. G0318 for use with home visits for new and established patients
    • CMS has also proposed not to adopt the general CPT rule in which a billable unit of time is considered to have been met once the midpoint is passed for the total time of that CPT code.
      • For example – CMS would not consider a service with a time description of 30 minutes to have been met if only 15 minutes of time was actually spent furnishing services.
  3.  Surgical CPT Code Revisions
    • Musculoskeletal System
      • Revision to the “suffix” description for 22857 – Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression); single interspace, lumbar
      • There is a new add-on code that is appropriate to use when the total disc arthroplasty is performed on the 2nd interspace of the lumbar spine.
        • +22860 – Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression); second interspace, lumbar (List separately in addition to code for primary procedure)
    • Respiratory System
      • 30469 is a new code added to identify the Repair of Nasal valve collapse with low energy, temperature controlled subcutaneous/submucosal remodeling
        • This includes bilateral repair. If the procedure is done unilaterally append
          modifier -52 for reduced services
    • Cardiovascular System
      • There are 5 new codes in the cardiovascular section for percutaneous pulmonary artery revascularization by stent placement.
        1. 33900 Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections, unilateral
        2. 33901 Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections, bilateral
        3. 33902 Percutaneous pulmonary artery revascularization by stent placement, initial; abnormal connections, unilateral
        4. 33903 Percutaneous pulmonary artery revascularization by stent placement, initial; abnormal connections, bilateral
        5. +33904 Percutaneous pulmonary artery revascularization by stent placement, each additional vessel or separate lesion, normal or abnormal connections (List separately in addition to code for primary procedure)
      • There are also 2 new codes for percutaneous arteriovenous fistula creation
        1. 36836 Percutaneous arteriovenous fistula creation, upper extremity, single access of both the peripheral artery and peripheral vein, including fistula maturation procedures (e.g., transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation
          • This new code specifically describes stent placement that is across major side branches.
          • The existing code 33895 Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; not crossing major side branches. This code only describes single access of both the peripheral artery and the peripheral vein including the fistula maturation procedures.
          • Additionally, 36837 Percutaneous arteriovenous fistula creation, upper extremity, separate access sites of the peripheral artery and peripheral vein, including fistula maturation procedures (e.g., transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation – this is used for separate access sites of the peripheral artery and peripheral vein including the fistula maturation procedures
          • The procedures bundle the vascular access, imaging guidance and the radiologic supervision and interpretation and should not be coded/billed separately.
    • Digestive System
      • There are 2 new EGD codes that describe the deployment and removal of intragastric bariatric balloon(s)
        1. 43290 Esophagogastroduodenoscopy, flexible, transoral; with deployment of intragastric bariatric balloon
        2. 43291 Esophagogastroduodenoscopy, flexible, transoral; with removal of intragastric bariatric balloon(s)
      • Additionally, there are several changes to codes in the Abdominal Hernia Repair section. Eighteen codes have been deleted from this section and replaced by 15 new codes. The new codes now include any approach as the procedures can be performed in a combination of approaches. Selection of the appropriate code is based on if the procedure is initial, recurrent, reducible, incarcerated, or
        strangulated, as well as the defect size. All of these new codes include mesh implant. There is also a new add-on code (+49623) for when non-infected mesh is removed, and this is only used with the subset of hernia repair codes 49591-49622.

        1. 49591-49596 identify the initial procedure
        2. 49614-49618 identify recurrent abdominal repairs
        3. 49621 and 49622 identify a parastomal repair
        4. +49623 Removal of total or near total non-infected mesh or other prosthesis at the time of initial or recurrent anterior abdominal hernia repair or parastomal hernia repair, any approach (ie, open, laparoscopic, robotic) (List separately in addition to code for primary procedure)
    • Urinary System
      • Two codes in this section have revised definitions to clarify the specific services that are included, simple vs. complex with size and examples defined.
        1. 50080 Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guidance; simple (e.g., stone[s] up to 2 cm in single location of kidney or renal pelvis, nonbranching stones)
        2. 50081 Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guidance; complex (e.g., stone[s] > 2 cm, branching stones, stones in multiple locations, ureter stones, complicated anatomy)
    • Male Genital System
      • There is one new code in this section.
        1. 55867 Laparoscopy, surgical prostatectomy, simple subtotal (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy), includes robotic assistance, when performed
    • Nervous System
      • Revisions to the definitions of the nerve injection series (64415-64417, 64445- 64448) have been revised to include imaging guidance when performed. Do not unbundle and bill for the imaging guidance separately.
    • Eye and Ocular Adnexa
      • There are minor revisions to two codes in this section. These have been revised to include an example of the procedure type (e.g., canaloplasty).
        1. 66174 Transluminal dilation of aqueous outflow canal (e.g., canaloplasty); without retention of device or stent
        2. 66175 Transluminal dilation of aqueous outflow canal (e.g., canaloplasty); with retention of device or stent
    • Auditory System
      • The following codes, 69716-69717, 69719, and 69726-69727 have been revised to clarify the description of an osseonintegrated skull implant replacement or removal. There are also three new codes in this section, note these codes are not in sequential order in the CPT code book.
        • 69728 Removal, entire osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside the mastoid and involving a bony defect greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex
        • 69729 Implantation, osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside of the mastoid and resulting in removal of greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex
        • 69730 Replacement (including removal of existing device), osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside the mastoid and involving a bony defect greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex
  4. Radiology
    • There is one new code and several description revisions to this section.
      • New Code
        1. 76883 Ultrasound, nerve(s) and accompanying structures throughout their entire anatomic course in one extremity, comprehensive, including real time cine imaging with image documentation, per extremity
      • Revised Codes
        • 76882 has been revised to include to include “focal evaluation of”
        • 78803, 78830-78832 have had the descriptors revised to include “or acquisition”
  5. Pathology and Laboratory
    • There are eleven new codes and 3 revised codes in this section
      • New Codes – 81449, 81451 and 81456 describe targeted genomic sequence analyses
        1. 81449 Targeted genomic sequence analysis panel, solid organ neoplasm, 5- 50 genes (e.g., ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, MET, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed; RNA analysis
        2. 81451 Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, 5-50 genes (e.g., BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NOTCH1, NPM1, NRAS), interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis
        3. 81456 Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes (e.g., ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MET, MLL, NOTCH1, NPM1, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis
      • New Codes – 87468, 87469, 87478, and 87484 describe infectious agent detections using DNA or RNA
        1. 87468 Infectious agent detection by nucleic acid (DNA or RNA); Anaplasma phagocytophilum, amplified probe technique
        2. 87469 Infectious agent detection by nucleic acid (DNA or RNA); Babesia microti, amplified probe technique
        3. 87478 Infectious agent detection by nucleic acid (DNA or RNA); Borrelia miyamotoi, amplified probe technique
        4. 87484 Infectious agent detection by nucleic acid (DNA or RNA); Ehrlichia chaffeensis, amplified probe technique (this code is out of sequence in CPT)
      • New Code 81418 added for drug metabolism analysis using genomic sequencing.
        1. 81418 Drug metabolism (e.g., pharmacogenomics) genomic sequence analysis panel, must include testing of at least 6 genes, including CYP2C19, CYP2D6, and CYP2D6 duplication/deletion analysis
      • New Code 81441 indicates the detection of inherited bone marrow failure syndromes (IBMFS)
        1. 81441 Inherited bone marrow failure syndromes (IBMFS) (e.g., Fanconi anemia, dyskeratosis congenita, Diamond-Blackfan anemia, Shwachman Diamond syndrome, GATA2 deficiency syndrome, congenital amegakaryocytic thrombocytopenia) sequence analysis panel, must include sequencing of at least 30 genes, including BRCA2, BRIP1, DKC1, FANCA, FANCB, FANCC, FANCD2, FANCE, FANCF, FANCG, FANCI, FANCL, GATA1, GATA2, MPL, NHP2, NOP10, PALB2, RAD51C, RPL11, RPL35A, RPL5, RPS10, RPS19, RPS24, RPS26, RPS7, SBDS, TERT, and TINF2
      • New Code 84433 indicates the detection of a specific enzyme TPMT
        1. 84433 Thiopurine S-methyltransferase (TPMT)
      • New Code 87467 indicates the detection of HepB surface antigen
        1. 87467 Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Hepatitis B surface antigen (HBsAg), quantitative
      • 81445, 81450 and 81455 were revised to update the placement of examples and descriptive wording, but the overall meaning of these code descriptions has not changed.
  6. Medicine Section
    • There were ten new codes and seven revised codes in this section
      • New Codes 93569 and 93573-93575 have been added. These are add-on codes that describe injection procedures for angiographies done during cardiac catheterization.
        1. 93569 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, unilateral (List separately in addition to code for primary procedure)
        2. 93573 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, bilateral (List separately in addition to code for primary procedure)
        3. 93574 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary venous angiography of each distinct pulmonary vein during cardiac catheterization (List separately in addition to code for primary procedure)
        4. 93575 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary angiography of major aortopulmonary collateral arteries (MAPCAs) arising off the aorta or its systemic branches, during cardiac catheterization for congenital heart defects, each distinct vessel (List separately in addition to code for primary procedure)
      • New codes 96202 and 96203 are for multi-family group behavior management/modification training.
        1. 96202 Multiple-family group behavior management/modification training for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of parent(s)/guardian(s)/caregiver(s); initial 60 minutes
        2. 96203 is the add-on code for each additional 15 minutes (List separately in addition to code for primary service 96202)
      • New RSV vaccine code 90678
        1. 90678 Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use
      • New Orthoptic training code 92066
        1. 92066 Orthoptic training; under supervision of a physician or other qualified health care professional
      • New Quantitative Pupillometry code 95919
        1. 95919 Quantitative pupillometry with physician or other qualified health care professional interpretation and report, unilateral or bilateral
      • New Remote therapeutic monitoring for cognitive behavior code 98978
        1. 98978 Remote therapeutic monitoring (e.g., therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor cognitive behavioral therapy, each 30 days
      • Code 92065 has been revised to include clarification that a physician or other qualified healthcare profession must perform the orthoptic training
      • Code 92229 has been revised and the term “automated analysis” has been replaced with “autonomous analysis” when referring to the retina imaging report.
      • Code 92284 has been revised to clarify this is a “diagnostic” exam
      • Code +93568 has been revised to clarify that this is an injection procedure done during cardiac catheterization
      • Codes 98975-98977 have been revised to remove some of the previously listed examples.

Download a PDF of the code changes here