CPT® 2024 Update: New Codes and Guidelines

2024 CPT Codes Update

 Take a look at the updates in CPT coding and guidelines for professional services.

Every year, on January 1st, updated CPT® codes and coding guidelines emerge, introducing new, revised, and eliminated codes. For instance, in CPT® 2024, there are 230 new codes, 70 revised ones, and 49 removed codes. Notably, no alterations apply to anesthesia, integumentary, digestive, male genital, or auditory systems. The most substantial modifications occur within evaluation and management (E/M) services, the phrenic nerve stimulation system, lab and pathology, COVID-19 and RSV vaccinations, and Category III codes. Below is a breakdown of the changes across sections.

Evaluation and Management

Within the E/M section, adjustments were made to the code descriptors of office and other outpatient visit codes (99202-99215). These revisions aimed to align their language with other E/M codes by removing specific time ranges. As an illustration, the descriptor for 99213 now states that “… 20 minutes must be met or exceeded.” It’s important to note that this editorial alteration doesn’t modify the time linked to each code.

Additionally within this section, E/M guidelines now cover split/shared visits. CPT® specifies that the significant part of the encounter involving medical decision making (MDM) necessitates physician(s) or other Qualified Healthcare Provider(s) (QHP) involvement in creating or approving the management plan for the complexity of problems addressed during the encounter. This involvement holds the responsibility for the plan, encompassing the inherent risks of complications and/or patient management’s morbidity or mortality. This means that a physician or other QHP fulfills two of the three elements used in selecting the code level based on MDM.

The guidelines also address data, constituting the third element of E/M. If code selection relies on time, the provider who predominantly spent the time during a split/shared visit should report the service.

Furthermore, additional guidelines were included to clarify reporting multiple E/M services on the same date, such as hospital inpatient and observation care or nursing facility visits, which are considered “per day” services. When a patient sees the same specialty provider multiple times within the same day and setting within the same group practice, a single E/M code is used. A thorough review of the detailed E/M guidelines is crucial for accurate E/M coding.

Moreover, within this section, revisions were made to two nursing facility codes: 99306 now specifies 50 minutes instead of 45 minutes, and 99308 denotes 20 minutes instead of 15 minutes.

Surgery: Musculoskeletal System

CPT® 2024 introduces three additional codes specifically for anterior thoracic vertebral body tethering. This method offers an alternative to the conventional spinal fusion surgery, which entails fusing vertebrae to stabilize the spine and restrict movement in fused segments. Anterior vertebral body tethering stands as a less invasive option enabling ongoing spinal growth and flexibility. Primarily performed on scoliosis patients, this procedure comes with introductory guidelines and accompanying parenthetical instructions for the following codes:

• cpt code 22836: Pertains to anterior thoracic vertebral body tethering for up to seven vertebral segments.
• cpt code 22837: Addresses anterior thoracic vertebral body tethering for eight or more vertebral segments.
• cpt code 22838: Relates to the revision, replacement, or removal of thoracic vertebral body tethering.

Additionally, a new code, cpt code 27278, has been included to document sacroiliac joint arthrodesis. This code specifically denotes the placement of an intra-articular stabilization device through a minimally invasive technique that doesn’t penetrate the joint.

The codes within the hallux valgus correction family (28292-28299) underwent revisions, eliminating the inclusion of bunionectomy within parentheses and providing clarification that the procedure specifically involves “with bunionectomy.”

Surgery: Respiratory System

Two new codes have been introduced to account for the destruction of the posterior nasal nerve during a nasal/sinus endoscopy. code cpt 31242 is now available to document the procedure when conducted using radiofrequency ablation, while code cpt 31243 is designated for the procedure performed with cryoablation.

Surgery: Cardiovascular System

CPT® 2024 introduces eight new codes tailored for the phrenic nerve stimulation system, accompanied by introductory guidelines and parenthetical guidance. The new codes are as follows:

• cpt code 33276 covers the insertion of the pulse generator and stimulating leads, along with the initial analysis of the generator involving diagnostic mode activation.
• +33277, an add-on code, denotes the insertion of the transvenous sensing lead.
•cpt 33278 is designated for the removal of both the pulse generator and lead(s).
• cpt 33279 specifically relates to the removal of only the leads.
• cpt code 33280 addresses the removal of solely the pacemaker.
• cpt 33281 pertains to the repositioning of the lead(s).
• cpt 33287 is allocated for the removal and replacement of the pulse generator.
• cpt 33288 is dedicated to the removal and replacement of the lead(s).

Surgery: Urinary System

The recently added code 52284 outlines cystourethroscopy involving mechanical urethral dilation and therapeutic drug delivery via a drug-coated balloon catheter for treating urethral stricture or stenosis in male patients. This procedure, which incorporates fluoroscopy, aims to address these specific conditions.

Surgery: Female Genital System

A newly introduced code, cpt code 58580, delineates the transcervical radiofrequency ablation of uterine fibroid(s). This procedure encompasses intraoperative ultrasound guidance and monitoring as part of its description.

Surgery: Nervous System

Three new codes have been introduced for procedures involving skull-mounted cranial pulse generator or receiver devices: cpt code 61889 for insertion, cpt code 61891 for revision or replacement, and 61892 for removal.

The revised code 63685, addressing the insertion or replacement of a spinal neurostimulator pulse generator or receiver, now stipulates the necessity of creating a pocket and establishing connection between the array and the pulse generator or receiver.

Similarly, the revision for the implanted spinal neurostimulator code 63688 now includes “with detachable connection to electrode array.”

Code 64590 has been updated to encompass “sacral” specifications and highlights the need for pocket creation and connection between the electrode array and pulse generator or receiver. Correspondingly, code 64595 now includes “sacral” and specifies the procedure with a detachable connection to the electrode array.

In addition, a new code, 64596, delineates the insertion or replacement of the initial electrode array for the percutaneous electrode array of a peripheral nerve with an integrated neurostimulator. An add-on code, +64597, accompanies 64596 for reporting each additional electrode array. Lastly, a new code, 64598, describes the revision or removal of the neurostimulator electrode array with an integrated neurostimulator of a peripheral nerve.

Surgery: Eye and Ocular Adnexa

The recently introduced code cpt 67516 details the administration of a pharmacologic agent into the suprachoroidal space. The medication itself is reported separately from this procedure.

Radiology

The cpt code 74710 for pelvimetry has been removed. In its place, cpt code 75580 has been introduced to characterize a noninvasive estimation of coronary fractional flow reserve (FFR), derived from software analysis augmenting the data set from a coronary computed tomography angiography. Additionally, a diagnostic intraoperative thoracic aorta ultrasound is now defined by new cpt code 76984.

For epicardial ultrasound concerning congenital heart disease, three new codes have been incorporated. When all facets of the procedure are conducted—including transducer placement, manipulation, image acquisition, interpretation, and reporting—the use of new cpt code 76987 is recommended. If the provider solely undertakes transducer placement, manipulation, and image acquisition, cpt code 76988 should be used. Similarly, if the provider exclusively performs the interpretation and reporting, cpt code 76989 is applicable.

Pathology and Laboratory

Several changes and additions have been made in this section. cpt Codes 81171, 81172, 81243, 81244, 81403, 81404, 81405, 81406, and 81407 underwent revisions, replacing the term “mental retardation” with “intellectual disability.”

Moreover, six novel genomic sequence analysis panel codes have been introduced for solid organ neoplasms:

• 81457: DNA analysis for sequence variants and microsatellite instability.
• 81458: DNA analysis for sequence variants, copy number variants, and microsatellite instability.
• 81459: DNA analysis or combined DNA and RNA analysis for sequence variants, copy number variants, microsatellite instability, tumor mutation burden, and rearrangements.
• 81462: DNA analysis or combined DNA and RNA analysis from cell-free nucleic acid for sequence variants, copy number variants, and rearrangements.
• 81463: DNA analysis for sequence variants, copy number variants, and microsatellite instability from cell-free nucleic acid.
• 81464: DNA analysis or combined DNA and RNA analysis from cell-free nucleic acid for sequence variants, copy number variants, microsatellite instability, tumor mutation burden, and rearrangements.

Additionally, a new multianalyte assays with algorithmic analyses (MAAA) code, 81517, has been added for liver fibrosis and liver-related clinical events within a five-year timeframe.

Another new code, 82166, outlines the chemistry test for anti-Müllerian hormone (AMH).

Furthermore, three new immunology codes were introduced for acetylcholine receptors (AChR):

86041: Includes binding antibody.
86042: Includes blocking antibody.
86043: Includes modulating antibody.

A new code, 86366, has been created for testing muscle-specific kinase (MuSK) antibodies, while codes 87523 and 87593 are designated for hepatitis D and orthopoxvirus testing (e.g., monkeypox virus, cowpox virus, vaccinia virus), respectively.

Additionally, numerous new proprietary laboratory analyses (PLA) codes have been included. These codes describe PLAs offered by a single laboratory or licensed for use by multiple laboratories, encompassing MAAA and genomic sequencing procedures (GSP).

Medicine

Two novel codes have emerged within the immune globulins subsection of the medicine section, specifically for respiratory syncytial virus (RSV). These codes, 90380 and 90381, pertain to the monoclonal antibody in a seasonal dose, with selection based on the dose: 0.5 mL and 1 mL, respectively.

Several alterations have occurred with COVID-19 vaccine codes; however, these updates are not reflected in the CPT® 2024 code book due to changes made post-printing. Notably, a new vaccination administration code, 90480, has been sanctioned to report administering any COVID-19 vaccine for any patient, replacing all previously established specific vaccine administration codes. This new administration code encompasses counseling.

Distinct product codes for Pfizer and Moderna vaccines have been introduced for different age groups. Pfizer codes 91318, 91319, and 91320 are designated for patients aged 6 months through 4 years, 5 through 11 years, and 12 years and older, respectively. Correspondingly, Moderna codes 91321 and 91322 are specified for patients aged 6 months through 11 years and 12 years and older.

Effective September 11, 2023, these new codes took effect, leading to the elimination of all previously approved COVID-19 vaccine supply and administration codes from the CPT® code set starting November 1, 2023. Detailed information on these changes can be found on the AMA website and the AAPC blog. They are also addressed in the CPT® Assistant Erratum for Special Edition: August Update, accessible on the AMA website.

Additionally, two new vaccine supply codes have been established for RSV: 90679 for reF, subunit, and bivalent, and 90683 for preF, recombinant, subunit, and adjuvanted, both intended for intramuscular use.

Four new codes have been introduced for the phrenic nerve stimulation system: 93150 for therapy activation, 93151 for interrogation and programming, 93152 for interrogation and programming during polysomnography, and 93153 for interrogation only, excluding programming.

Furthermore, five new add-on codes have been created for venography related to congenital heart defects. These codes encompass catheter placement and radiological supervision and interpretation. They are delineated as follows: +93584 for anomalous or persistent superior vena cava, +93585 for azygos/hemiazygos venous system, +93586 for the coronary sinus, +93587 for venovenous collaterals originating at or above the heart, and +93588 for venovenous collaterals originating below the heart.

Additionally, three new codes (97550-97552) have been introduced for caregiver training.

Category III Codes

Numerous new  Category III codes have been introduced, highlighting innovative and emerging technologies. Among them are a range of codes such as add-on codes +0827T through +0856T for digital pathology digitization procedures, codes 0795T through 0804T for dual-chamber leadless pacemakers, and codes 0820T, +0821T, and +0822T for continuous monitoring and intervention during psychedelic medication therapy.

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