Upcoming CPT Changes Now Effective as of January 1, 2021

This month “Spotlight on CPT” looks at some of the upcoming CPT coding changes that are now effective as of January 1, 2021.  There are 329 code changes with the update.  Of those, 206 are new codes, 54 are codes that have deleted, and 69 codes have undergone a revision. 

The good news is that approximately two-thirds of the changes take place with laboratory, specifically the Proprietary Laboratory Analyses (PLA) section, and Category III codes.  The PLA codes, which are alpha-numeric, allow labs or manufacturers to have codes that specifically identify their tests.         

The radiology section has a much smaller number of changes, only 10 in total; with 2 new, 6 revised, and 2 deleted.  The laboratory and radiology updates usually do not impact coding professionals unless they are directly involved in updating the chargemaster.  However, it is a good idea to make sure that those departments are aware of the changes and have requested the necessary chargemaster updates according to facility policy.

All the buzz this year regarding CPT has centered around the E&M changes.  These are focused on the office visit codes for new or established patients and prolonged services codes.  Key takeaways include:

               Deletion of 99201 for the lowest level of new patient visit

               Focus on time and medical decision making as the basis for code assignment

               Revision of prolonged service codes

There are other areas addressed with the update that should not be overlooked.  This includes an extensive revision in the integumentary system for breast repair and/or reconstruction.  Terminology update is one of the changes where the term mammaplasty is replaced in favor of procedure specificity.  The term mammary is also replaced with breast.  There is also revision in descriptions of flap procedures. 

Two new codes are provided for nasopharyngoscopy.   These represent surgical procedures with dilation of eustachian tube.  The distinction between the codes shows whether the procedure was performed unilaterally or bilaterally. 

Keep an eye out for the four new codes that cover auditory evoked potentials.  Similarly, there are eight new codes that address external electrocardiographic recording.  These codes are broken down by time, with one set of codes for more than 48 hours up to seven days, and the second set for more than seven days to up to fifteen days. 

This is a quick overview of some of the changes seen with the CPT update.  Remember, the easiest place to get a full overview of the changes is in Appendix B-Summary of Additions, Deletions, and Revisions in the CPT Manual itself. 

Now, light has been shed on upcoming CPT changes.

 

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

Unlisted CPT Codes

What is an unlisted CPT code?  That is the question “Spotlight on CPT” will address this month. 

Unlisted CPT codes are those that are meant to be assigned when the procedure performed by a provider is not found in the CPT code set.  It could be a brand-new procedure, or one that is not fully explained by an existing CPT code. 

Unlisted CPT codes are sprinkled throughout the CPT manual and each one relates to a specific section of the manual.  Unlisted codes are noted in the guidelines which precede each section of the code book.  For example, in the Anesthesia section guidelines code 01999 is identified as the only unlisted anesthesia code, whereas, in the Pathology and Laboratory guidelines, there are sixteen unlisted codes for use depending on which type of path/lab test it is (chemistry, immunology, microbiology, etc.).

Most unlisted CPT codes end in 99.  Of course, there are some exceptions with unlisted codes ending in 00, 01, 29, 38, 39, 49, 59, 78, 79, 86, 96, 97, or 98.     

When coding unlisted procedures, it is often necessary to supply a special report that can provide specific information about the procedure so that reimbursement can be determined.  Details that should be included in the report include how much time and effort the procedure took, what equipment was needed, and a complete description of the procedure along with the medical necessity for it.

Remember, that when assigning CPT procedure codes, it is not acceptable to use a code that is “close” to the procedure that was actually performed.  If there is not a specific CPT code for the procedure/service that was performed, an unlisted code should be assigned instead.  

Now, light has been shed on unlisted CPT codes.

 

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.