CPT Code Adjustments for 2024

1
CPT Changes 2024

• Lynn M. Anderanin
• CPC, CPMA, CPB, CPC-I, CPPM, COSC

2
Inpatient and Observation

• Modifier 25 can be reported on these codes to
  identify subsequent services to another visit at
  another site of service on the same day
• Discharge services can only be reported by the
  discharging provider
• 99221-99223- First encounter with the patient who
  has not received any professional services from
  the provider or other provides of the exact same
  specialty and subspecialty who belongs to the
  same group
• If using time, this is reported by calendar date.
  Continuous service over two calendar days is
  reported on one calendar date.

3
Emergency Services- 99282-99285

• Time cannot be used to determine level
• 99281 is now equivalent to 99211. Description
  says this service does not require the presence
  of a physician or QHP.
• Can be reported with critical care on the same
  day
• 99242-99245 can be reported for consultations
  performed in the ED
• Appropriate modifier(s) should be used for
  services not completed or part of a surgery
  practice (e.g. 52,53,54,55,56)
• 99202-99215 should be used to report ED visits
  performed for physician convenience

4
Nursing Facilities-99304-99316

• Used for services at nursing and skilled nursing
  facilities
• Also use for psychiatric treatment center and
  immediate care facility for patients with
  intellectual disabilities.
• Performed by principal provider (admitting
  provider) overseeing the care of the patient.
• Multiple morbidities requiring intensive
  management added to high risk for nursing
  facility visits.
• Discharge services require a provider
  face-to-face with the patient on the date of
  discharge
• 99318 is replaced by 99307-99310

5
Home or Residence Services99341,99342,99344,99345
,99347-99350

• Includes domiciliary, rest home, custodial care
  service, and home care plan oversight services
• Some domiciliary services will be reported with
  99347,99491,or 99492
• Travel time is not included
• Prolonged service code is 99417
• 99343 is replaced by 99341,99342,99344, or 99345

6
Prolonged Services

• Add on codes 99417, 99418
• Can be used if there is more than one provider
  involved with the patient
• Primary codes- 99205, 99215, 99223, 99233, 99236,
  99245, 99255, 99306, 99310, 99345, 99350, 99483

7
Split or Shared Visits

• Provider that performs substantive portion if
  time is used
• For Medical Decision Making
• Whomever performs the problems addressed at the
  encounter and the risk of complications for the
  patient
• In order to use data reviewed and analyzed
  because the history of the patient by an
  independent historian or the ordering of tests do
  not need to be performed by the provider, in
  order to use this as an element the provider must
  perform an independent interpretation of test(s)
  or the discussion of a plan or test
  interpretation must be performed by the reporting
  provider

8
Telehealth

• Health and well-being coaching- 2024
• Social Determinants of Health Risk Assessment-
  permanent
• Accepting that patient can be in their home- paid
  at non-facility rate
• Adding applicable providers- qualified
  occupational therapists, qualified physical
  therapists, qualified speech-language
  pathologists, and qualified audiologists
• Define direct supervision to permit the presence
  and immediate availability of the supervising
  practitioner through real-time audio and video
  interactive telecommunications through December
  31, 2024
• COVID-19 PHE for Medicare telehealth services at
  least until the end of 2024

9
Phrenic Nerve Stimulation

• 33276 Insertion of pulse generator and
  stimulating lead(s)
• 33277 Insertion of transvenous sensing lead
• 33278 Removal of pulse generator and lead(s)
• 33279 Removal of transvenous lead(s) only
• 33280 Removal of pulse generator only
• 33281 Repositioning of lead(s)
• 33287 Removal and replacement of pulse generator
• 33288 Removal and replacement of lead(s)

10
Chemistry, Immunology, and Microbology

• 82166 AMH Antu-mullerian hormone
• 86041 AChR receptor binding antibody
• 86042 Blocking antibody
• 86043 Modulating antibody
• 87523 Nucliec acid to detect infectious agent
  detection of hepatitis D quantification, when
  performed
• 87593 Orthopoxvirus

11
SARS-CoV-2 Vaccinations

• 0121A IM injection SARS-CoV-2 vaccine, mRNA-LNP,
  bivalent spike protein, preservative free,
  30mcg/0.3ml dosage, tris-sucrose formulation,
  single dose
• 0151A IM injection SARS-CoV-2 vaccine, mRNA-LNP,
  bivalent spike protein, preservative free,
  10mcg/0.2ml dosage, diluent reconstituted,
  tris-sucrose formulation, single dose
• 0171A IM injection SARS-CoV2 vaccine, mRNA-LNP,
  bivalent spike protein, preservative free,
  3mcg/0.2ml dosage, diluent reconstituted,
  tris-sucrose formulation, first dose
• 0172A second dose

12
Thank You!!!

• Register Now