Among the most significant updates to the medical code system are changes to the Current Procedural Terminology (CPT) codes. Due to their close connection to billing and reimbursement needs, falling behind in understanding these changes can quickly damage your organization’s bottom line.
There have been 225 additions, 75 deletions, and 93 revisions to CPT 2023. The CPT guidelines have also undergone multiple revisions and additions. Below are some key coding changes to improve your 2023 workflow.
Emerging Concerns Create New Codes to Know
Vaccination guidelines for COVID-19 have evolved to include a second booster dose and vaccinations for children, which has affected coding structures as well. There are seven new product codes and 20 administration codes in the 2023 guide, as well as specific pediatric population codes for patients aged 5-11 years, six months to 4 years, and six months to 5 years.
The 2023 CPT edition addresses newly emerging concerns including Monkeypox and Smallpox. The Centers for Disease Control and Prevention (CDC) has aligned with the World Health Organization’s (WHO’s) terminology change from monkeypox to Mpox. A new code for Mpox laboratory testing, 87593, is available along with two additional codes related to Mpox and Smallpox vaccines. These additional codes have now been added to this year’s manual. (90611 and 90622).
Evaluation and Management
To bring all E/M categories in line with the guidelines in CPT 2021, the E/M section has been overhauled. This section contains many code changes, and a thorough review is prudent for most practices. Considering these changes, the Centers for Medicare & Medicaid Service (CMS) 1995 or 1997 Documentation Guidelines for E/M Services are no longer relevant. With some modifications, CMS plans to accept the CPT 2023 E/M guidelines in the proposed Medicare Physician Fee Schedule (PFS) for 2023. Having one set of guidelines for E/M services is designed to alleviate some of the administrative burdens on providers, coders, and auditors.
Additional new patient codes (99201–99205) now require all three key evaluation components, including history, exam, and medical decision making, while the established codes (99211–99215) require only two.
New Digestive Surgery Codes
There is new coding for bariatric surgery, specifically esophagogastroduodenoscopy (EGD) with a bariatric balloon. Code 43290 indicates EGD with intragastric bariatric balloon deployment, while code 43291 indicates EGD with intragastric balloon removal.
Due to the procedure’s recent, increasing frequency, an official procedure code has been created for 30469, which describes the repair of nasal valve collapse with radiofrequency.
Hernia repair codes have been updated to include epigastric, incisional, ventral, umbilical, and spigelian hernias. A total of 18 codes were deleted and 15 new codes have been added. There are also changes that include introductory guidelines and parentheticals. In a hybrid model, these procedures are performed by combining different approaches. Codes differ depending on whether the procedure is initial or recurrent, reducible, incarcerated, or strangulated, and includes the total defect size. Select codes 49591-49596 for the initial procedure, codes 49614-49618 for recurrent abdominal hernia repairs and codes 49621 and 49622 to describe the repair of a parastomal hernia.
Mesh implantation is included in all new procedures. Report add-on code 49623 along with the code for the hernia repair if noninfected mesh is removed during the procedure. Only codes 49591 and 49622 can be reported with this new add-on code.
Auditory System Changes
Osseointegrated implant procedure codes 69717, 69719, 69726, and 69727 have been revised, and three new codes have been added. Code 69728 describes the removal of the Osseointegrated implant with magnetic transcutaneous attachment to an external speech processor outside of the mastoid resulting in the removal of greater than or equal to 100 sq mm surface area of bone. Code 69729 describes the implantation of the Osseointegrated implant with magnetic transcutaneous attachment to an external speech processor outside of the mastoid that results in the removal of greater than or equal to 100 sq mm surface area of bone. Code 69730 describes the replacement including the removal of the implant with magnetic transcutaneous attachment to an external speech processor outside of the mastoid that results in the removal of greater than or equal to 100 sq mm surface area of bone.
New Cardiac Catheterization Subcategory Codes
In cardiac care, code 93569 describes unilateral selective pulmonary arterial angiography.
Bilateral selective pulmonary arterial angiography is described by code 93573.
The code 93574 is attached to selective pulmonary venous angiography for each distinct pulmonary vein and code 93575 is indicated in selective pulmonary angiography of the major aortopulmonary collateral arteries that arise from the aorta or its systemic branches.
Yearly Changes to the CPT Have Become Increasingly Important
Learning these new CPT codes will help streamline your reporting, increase accuracy and efficiency, and create a better bottom line in 2023.
If your practice requires assistance with the new code set adjustments or requires additional manpower processing claims accurately, be sure to explore VOW’s medical coding services along with athenaOne®. Our coding experts can help; contact us at 412.42.2260 | info@vowhs.com.