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AMA Introduces CPT Code Set for 2023: A Noteworthy Integration of AI, Virtual Technology, and E/M Co

As with every passing year, this one is no different in introducing a myriad of changes to coding. CPT® 2023 brings 225 new, 93 revised, and 75 removed codes to the table. There are modifications in every section of the CPT® 2023 code set, except anesthesia. Major changes encompass evaluation and management (E/M), percutaneous pulmonary artery revascularization, hernia repairs, lab and pathology, and COVID-19 vaccination codes. In addition, two new appendices are included for artificial intelligence (AI) taxonomy (Appendix S) and synchronous real-time interactive audio-only telemedicine services (Appendix T). This article will provide a synopsis of these changes, effective from Jan. 1, 2023.


Evaluation and Management Update

The E/M section receives a major overhaul aligning all E/M categories with guidelines issued in CPT® 2021. A close examination is required for these changes, which render the Centers for Medicare & Medicaid Services’ (CMS’) 1995 or 1997 Documentation Guidelines for E/M Services obsolete. In the proposed 2023 Medicare Physician Fee Schedule (PFS) rule, CMS plans to accept the CPT® 2023 E/M guidelines with some changes. The details of these modifications were not available at the time of writing. This shift to a unified set of guidelines for E/M services is significant and should alleviate administrative burdens on providers, coders, and auditors.


The medical decision-making (MDM) table is updated for compatibility with all other E/M categories where MDM is a coding option. Added definitions throughout the guidelines offer examples and clarification for the use of MDM for code selection in other categories. There are also changes in the total time descriptors, now moving away from a time range to a specific minimum time requirement for code descriptors.


The subcategory for Hospital Observation Services and Domiciliary, Rest Home, or Home Care Oversight Services is eliminated. In CPT® 2023, observation care services will now be reported with hospital inpatient services codes, revised to include hospital inpatient and observation care services. The Domiciliary, Rest Home, or Custodial Care Services codes are also deleted and integrated with Home Services codes 99341-99350, except for deleted code 99343.


Despite the anticipation for the complete removal of consultation services, only level one consultation codes 99241 and 99251 are deleted. This is because consultation services, although not reimbursed by Medicare, are distinguished from other E/M services by medical specialties and better described by consultation code descriptors.


Emergency department visits (99281-99285) are now reported based on MDM only, as the total time concept is not applicable in the ED setting. Another introduced coding concept is that 99281 may not require the presence of a physician or other qualified healthcare professional, similar to 99211 in the office and outpatient setting.


For the annual nursing facility assessment code 99318, you'll need to use the subsequent nursing facility care codes (99307-99310) or Medicare G codes instead. New guidelines also exist for revised nursing facility care codes.


Finally, in this section, a new prolonged services add-on code (99418) is introduced for use after reaching the highest level of E/M, based on total time in inpatient and observation care or nursing facility. This add-on code is reported in 15-minute increments. Revised code 99417 can be reported with home and residence services and outpatient consultation codes.


Revisions and Additions in the Surgical Section

There are revisions and additions in various subsections of Surgery, including the integumentary system, musculoskeletal system, respiratory system, cardiovascular system, digestive system, urinary system, male genital system, nervous system, eye and ocular adnexa, and auditory system. Each of these subsections has specific changes that professionals in the respective fields need to be aware of.


Radiology, Pathology, and Laboratory Changes

In the Radiology section, the descriptor for limited ultrasound code 76882 is revised to include “focal evaluation of,” and descriptors for tomographic SPECT codes 78803, 78830, 78831, and 78832 are updated to include “or acquisition.” New code 76883 describes an ultrasound of the nerves and accompanying structures in one extremity.


Pathology and Laboratory see the addition of a new code, 81418, which describes a drug metabolism genomic sequence analysis panel. Another new code, 81441, describes inherited bone marrow failure syndromes testing. A set of codes, 81445, 81450, and 81455, are revised to specify that the procedure includes DNA analysis or combined DNA and RNA analysis. New codes 81449 and 81451 are introduced for cases where the targeted genomic sequence analysis panel involves only RNA analysis.


Medicine

Codes for COVID-19 vaccines are issued in light of the ongoing public health emergency. The vaccine administration codes include the type of vaccine and the number of doses. For accurate reporting, there is an administration code and a supply code (if your provider did not receive the supply of the vaccine for free). Appendix Q provides coding clarification on the correct use of the COVID-19 vaccine administration and supply codes.


Four new codes have been introduced for angiography procedures in the cardiac catheterization subcategory.


Category III Code Changes

New Category III codes have been added for cutting-edge technology. These include 0751T-0763T for digital pathology digitization procedures, 0764T-0765T for assistive algorithmic EKG risk-based assessment, 0766T-0769T for transcutaneous magnetic stimulation of nerves for chronic nerve pain, and 0771T-0774T for virtual reality patient procedural dissociation.


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