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CPT Codes Articles

Flu Vaccination Coding and Billing for 2022 – 2023 November 9, 2022

flu vaccine 2022-2023

The Food and Drug Administration (FDA) Vaccines, and Related Biologic Products Advisory Committee selected vaccine strains for the 2022–2023 influenza vaccine. Also, the World Health Organization recommended the Northern Hemisphere as the basis for the 2022-2023 influenza vaccine composition.

Want more details? Visit the Centers for Disease Control (CDC) Flu Season web page for more information about the flu vaccines for 2022-2023.

Billing/Reporting Influenza Vaccines for Medicaid Beneficiaries 

Depending on the age of the beneficiaries and vaccine formulation, the vaccine codes listed below may either be reported (with no charge) or billed (with a charge as usual and customary). The tables also show the administration codes that may be billed, depending on the beneficiaries’ age and vaccine(s) provided to them.

Vaccine CPT Codes to Report

Source: North Carolina Department of Health and Human Services (NCDDHS).

Table 1. A list of influenza billing codes for Medicaid beneficiaries under 19 years of age who receive the VFC influenza vaccine. The reporting of these codes results in a 0.00 dollar amount.

Providers should use the NDC on the actual vial used for administration listed at the bottom of this bulletin when processing claims.

Important Note: In the Health Check Billing Guide, you can find specific information about billing immunization administration codes for Health Check beneficiaries. 

Source: North Carolina Department of Health and Human Services (NCDDHS)

Table 2: Influenza Billing Codes for Medicaid Beneficiaries 19 to 21 Years of Age

Providers should use the following codes to bill for influenza vaccines purchased and administered for Medicaid beneficiaries between the ages of 19 and 21. 

Important Note: The VFC/NCIP provides influenza vaccines only to recipients between the ages of six months and 18 years old. However, those 19 years and older will not receive the influenza vaccine.

Vaccine CPT Codes to Report

Source: North Carolina Department of Health and Human Services (NCDDHS)

Administrative CPT Codes to Report

Source: North Carolina Department of Health and Human Services (NCDDHS)

Table 3: Influenza Billing Codes for Medicaid Beneficiaries 21 Years of Age and Older

The administrative CPT code 90472 will only be used if another vaccine is also administered along with the influenza vaccine. Moreover, it’s possible for providers to bill 90472 in more than one unit, if necessary.

In the event that beneficiaries 21 years of age and older purchase or receive an influenza vaccine, providers should use the following codes to bill Medicaid.

Important Note: Only VFC-age beneficiaries (6 months through 18 years of age) are eligible for influenza products under the VFC/NCIP. However, those 19 years and older will not receive the influenza vaccine.

Vaccine CPT Code to Report

Source: North Carolina Department of Health and Human Services (NCDDHS)

Administrative CPT Code(s) to Bill

Source: North Carolina Department of Health and Human Services (NCDDHS)

The administrative CPT code 90472 will only be used if another vaccine is also administered along with the influenza vaccine. Moreover, it’s possible for providers to bill 90472 in more than one unit, if necessary.

For beneficiaries 21 years or older receiving an influenza vaccine, an evaluation and management (E/M) code cannot be reimbursed to any provider on the same day that injection administration fee codes (e.g., 90471 or 90471 and +90472) are reimbursed.

Any healthcare provider cannot reimburse an evaluation and management (E/M) code for beneficiaries 21 years and older who are receiving influenza vaccinations on the same day as injection administration fee codes (e.g., 90471 and +90472). For billing a separately identifiable service, the provider must add modifier 25 to the E/M code.

Flu Vaccination Coding and Billing for 2022-2023

As shown in Table A, Medicare Part B payment allowances increased slightly for the 2022-2023 flu season.

Table A: Comparison of CPT® code and Medicare Part B payment allowances for 2021-2022 and 2022—2023 flu seasons

Medicare Part B payment allowances are 95 percent of the average wholesale price (AWP) for influenza vaccines, except in cases where vaccines are provided in outpatient departments of hospitals, rural health clinics, or Federally Qualified Health Centers.

Important Note: In one calendar year, Medicare patients can receive two fully-covered flu vaccinations due to the annual flu season that runs from Aug. 1 to July 31.

When a patient receives a flu shot on Jan. 5, 2022, and again on Aug. 29, 2022, Medicare will pay for both vaccinations. 

As usual, vaccinations against the influenza virus do not apply toward the annual Part B deductible or coinsurance amounts.

In accordance with Medicare guidelines, providers must report ICD-10-CM code Z23 Encounter for immunization together with administration code G0008 Administration of influenza virus vaccine.

While vaccine product pricing is updated on Aug. 1, G0008’s pricing is effective Jan. 1 through Dec. 31. Physicians can now download the 2022 Medicare Physician Fee Schedule (MPFS) payment rates file from the Centers for Medicare & Medicaid Services (CMS), which includes locality-adjusted payment rates for influenza, pneumococcal, and hepatitis B vaccine administration.

Important Safety Information for Physicians Administering Flu Vaccines

It is not recommended to administer Fluzone Quadrivalent, Flublok Quadrivalent, or Fluzone High-Dose Quadrivalent to anyone who has had a severe allergic reaction (e.g., anaphylaxis) to any component of the vaccines (including egg protein for Fluzone Quadrivalent and Fluzone High-Dose Quadrivalent) or after a previous dose.

It is also not recommended to administer Fluzone Quadrivalent or Fluzone High-Dose Quadrivalent to anyone who has had an allergic reaction to any influenza vaccine in the past.

The Fluzone Quadrivalent injection site reactions in pain, tenderness, erythema, and swelling in children 6 months to 35 months of age. Acute injection-site reactions (pain, erythema, and swelling) are the most common in children 3 years through 8 years of age. Systemic adverse reactions include myalgia, malaise, and headaches. The most common solicited systemic adverse reactions in adults 18 years, and older were myalgia, headache, and malaise.

There was a higher frequency of pain at the injection site in adults 65 years of age and older, as well as headache, malaise, and myalgia in systemic adverse reactions to Fluzone High-Dose Quadrivalent.

It is possible that other adverse reactions will occur with Fluzone Quadrivalent, Flublok Quadrivalent, and Fluzone High-Dose Quadrivalent.

For all Fluzone Quadrivalent, Flublok Quadrivalent, and Fluzone High-Dose Quadrivalent vaccine products, please see the complete Prescribing Information. Also, you can check out the complete Patient Information for Fluzone Quadrivalent or Fluzone High-Dose Quadrivalent.

Influenza Vaccine Products for the 2022 – 2023 Influenza Season

Source: Immunize.org

Get ready for the 2022-2023 influenza season!

Using this article as a guide, we hope you will be able to administer flu vaccination codes more easily. For more information, you can also refer to this source.

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At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.

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ICD-10, and CPT E/M Code Updates for 2023 September 30, 2022

2023 e/m changes

Do you want to learn more about the 2023 CPT® Evaluation and Management (E/M) changes? In the CPT® book, the E/M section has been updated significantly.

This article discusses the ICD-10 and CPT E/M Code Updates for 2023.

CPT® Evaluation and Management (E/M) Code Updates

As of January 1, 2023, changes have been made to the CPT Evaluation and Management (E/M) codes by the American Medical Association (AMA). Moreover, E/M codes for office/outpatient visits were updated in 2021 to reduce documentation and focus on medical decision-making. The full details have not yet become public, but a summary of proposed changes is listed below:

The tables below include the following CPT E/M code changes, effective January 1, 2023:

Deleted CPT E/M Codes

AMA 2023 E/M Updates

Evaluation and Management (E&M) Visits

With the continued update of CPT® coding and related guidelines, the AMA CPT® Editorial Panel approved revised coding and updated guidelines for Other E&M visits that will take effect on January 1, 2023. The AMA proposes adopting most of these changes in coding and documentation for other E&M visits, which include:

  • Hospital Inpatient/Observation
  • Emergency Department
  • Nursing Facility
  • Home or Residence Services
  • Cognitive Impairment Assessment

These changes will be effective January 1, 2023, similar to the final rule they approved in the CY 2021 PFS final rule for office/outpatient E&M visits. Among the changes to this revised coding and documentation framework are changes to CPT code definitions, including: 

  • New description times (where relevant).  
  • Interpretive guidelines for medical decision-making at different levels have been revised.  
  • Code level selection for medical decision-making (except for emergency department visits and cognitive impairment assessments, which are not timed).  
  • The history and exam to determine code level will no longer be used (instead, a medically appropriate history and exam will be required).

The AMA proposes maintaining the current billing policies that apply to E&Ms while considering any revisions necessary for future rulemaking. Furthermore, they suggest introducing Medicare-specific coding for payment of Other E&M prolonged services, as the Centers for Medicare & Medicaid Services (CMS) did for Office/Outpatient prolonged services in CY 2021.

The following list below contains some “key” revisions to the 2023 E&M code descriptors and guidelines.

  • There will be a deletion of observation CPT® codes (99217-99220, 99224-99226) and a merging of them with the existing hospital care codes (99221-99223, 99221-99233, 99238-999239) and updated code descriptions.
  • With the removal of some confusing guidelines, including the definition of “transfer of care,” consultations will get a facelift. In keeping with the deletions at level one due to MDM duplication, the low-level office (99241) and inpatient (99251) consultation codes will be deleted to align with the four levels of MDM.
  • As with the revisions to office visits in 2021, nursing facility and home and residence services will also undergo modifications.

The AMA says E/M code changes will simplify physician notations and reduce burnout. With the new code changes, finding the correct code should be more accessible, streamlining administrative processes. Consequently, direct care workers and facility staff can interact with patients more.

To help with the impending changes, the AMA also offers several resources

Summary of the 2023 ICD-10-CM Code Updates

Furthermore, the Centers for Disease Control and Prevention (CDC) recently released the ICD-10-CM code set for the fiscal year 2023, along with the ICD-10-CM Official Coding and Reporting Guidelines, which introduce new codes and guidelines for reporting dementia, head injuries, and long-term drug treatment. The 2023 ICD-10-CM update will add 1,176 new codes, revise 28, and delete 287. For patient encounters and discharges, physicians must use these codes between October 1, 2022, and September 30, 2023.

Eighty-three new ICD-10 codes were added to Chapter 5 (Mental, Behavioral and Neurodevelopmental disorders [F01-F99]); the table below shows a sample of its code updates.

In total, 69 new codes are available for dementia associated with or without psychological symptoms. Here are a few of the new dementia codes:

Other Examples of ICD-10-CM Code Updates for 2023

Stay On Top of ICD-10 and CPT E/M Code Updates

Whenever codes are revised, and new rules come into effect, it is crucial that providers check with their EHR vendors to ensure that their systems are aligned. Make sure your EHR vendor’s coding applications will adhere to the new evaluation and management code updates for 2023.

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Best Guide to E-Visit Documentation, Coding, and Billing August 3, 2022

coding

The American Academy of Family Physicians (AAFP) encourages safe, secure online interactions between physicians and patients, such as electronic visits or “virtual e-visits.” In non-emergency situations, e-visits can substitute for office visits with primary care providers. It is a fast and easy online procedure for patients to receive a diagnosis and treatment plan.

This article will give you the best guide to e-visit documentation, coding, and billing.

What Should Providers Know About E-visits? 

An encounter must meet the following criteria to be considered an e-visit:

  • The practice must have a well-established relationship with its patients.
  • E-visits require patient consent and a communication request.
  • The patient must initiate non-face-to-face electronic communication. For example, patient portal systems.
  • Patients must not have seen an office visit to a physician or therapist for the same clinical concern in the past seven days.
  • It is only possible to report e-visits every seven days.
  • An e-visit is not the same as typical therapy sessions.

For e-visits, the following documentation requirements are needed:

  • The main complaint with all evaluation and management services (E/M).
  • The specifics of treatments, assessment of diagnoses or symptoms, evaluation, and conversation.
  • An official patient consent record is backed up by a signature and captured in the clinical note. Moreover, e-visit software platforms accept scanned copies of signed consents. Some systems allow electronic signatures.
  • The total time recorded over the seven days supporting the billable service.

List of Current Procedural Terminology (CPT) Codes That Require Providers to Follow Policies Set by Payers

The codes for online digital evaluation services (e-visits) used by doctors are complex. Below are the codes used:

Medicare uses the following HCPCS codes and descriptors for qualified non-physician professionals for its online digital evaluation service (e-visit):

Private payers and workers’ compensation are using the following online digital evaluation service (e-visit) CPT codes and descriptors:

Do’s and Don’ts in Billing E-Visits

When the following conditions are met, you can bill an e-visit:

  • The provider establishes a relationship with the patient.
  • Response time by the provider is longer than five minutes.
  • A provider responds through the patient portal to a message initiated by the patient.
  • A visit meets the 2021 E/M guidelines. 
  • It has been seven days since the clinician last saw the patient.
  • There is no global period for the same or similar condition for the patient.
  • In this case, the provider is making a clinical decision that would normally be performed in the office (e.g., medication dose adjustment, ordering a test, or prescribing a new medication).
  • A patient has consented to the e-visit and understands that he may be billed.
  • For online digital E/M services, the service period includes all related work done within seven days by the reporting individual and other registered healthcare providers (RHPs) in the same group practice.
  • The 7-day period begins when the reporting provider reviews the patient’s inquiry personally for the first time.
  • A new/unrelated problem from the patient arises within seven days of the previous E/M visit for a different issue.

Do not bill an E-visit in the following situations:

  • During the 7-day period, the provider may bill for other separately reported services (such as care management, INR monitoring, remote monitoring, etc.)
  • The same or similar condition was billed to the patient for an e-visit within the past 7 days. 
  • The patient inquires about a surgical procedure that happens during the surgery’s postoperative period (global).
  • Providers are simply disseminating results, processing medication requests, or scheduling appointments (for billing, E/M services must be performed).
  • A separate face-to-face E/M service (either in person or via telehealth) happens (included in the E/M) during the 7-day period of the e-visit.
  • Besides clinical staff time, only provider time can be included.

The AAFP published an algorithm in response to the growing number of virtual visits. It was developed by James Dom Dera, MD, FAAFP, to determine which code should be used for virtual services.

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New CPT Codes for Digital Therapies and Telemedicine June 29, 2022

digital cpt codes online

Physicians can now administer safe treatments to non-COVID and COVID patients using telemedicine. Also, it enables small health care practices to remain in business and even extend the services they offer. 

With this new technology, patients can easily schedule appointments, view their medication histories, and communicate with their doctors. Telemedicine will continue to enhance remote health care for many years to come. 

Meanwhile, accurately tracking telehealth reimbursements can directly impact the bottom line of your health care practice. Our new list of CPT codes for digital therapies and telemedicine helps you facilitate better management of telehealth billing.

CPT Codes for Telemedicine/Telehealth

The following codes are commonly reported for Medicare patients:

CPT Codes for Telehealth VisitsDescription of Service
99201-99205Office/outpatient evaluation and management (E/M) visit, new
G0425 – G0427Consultations, emergency department, or initial inpatient (Medicare only)
Virtual Visit/Check-Ins CPT CodesDescription of Service
CPT Code G2010Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
CPT Code G2012Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

In addition, the Centers for Medicare & Medicaid Services (CMS) created two additional G codes for billing by practitioners who cannot independently bill for E/M services. G2250 and G2251 are CPT codes billable by a selected group of nonphysician practitioners based on their benefit categories.

HCPCS G CodeDescription of Service
G2250Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous seven days nor leading to a service or procedure within the next 24 hours or soonest available appointment.
G2251Brief communication technology-based service, e.g., virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous seven days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
G2252 (CMS permanently establishes separate coding and payment for the extended virtual check-in service, G2252, effective January 1, 2022.) The reimbursement amount has been cross-walked to the reimbursement for Current Procedural Terminology (CPT) code 99442.Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion.

Telephone Evaluation & Management (E/M) Services

CPT codes for telephone E/M are time-based. In addition, payments for telephone E/M services CPT codes 99441-99443 are equivalent to 99212-99214 and can be used for new or established patients during the Public Health Emergency (PHE). Modifier 95 should be applied, and the place of service (POS) should be where the visit would have taken place in person before the public health emergency (e.g., 11-Office, 22-Hospital Outpatient, 23-ASC). Before reporting codes for non-Medicare beneficiaries, ensure that your commercial payers cover these services.

CPT Code 99441For any new or established patients, telephone or audio-only evaluation and management services cannot originate from a related E/M service provided within the previous seven days nor lead to an E/M service or procedure within the next 24 hours or as soon as the earliest available appointment, 5-10 minutes of medical discussion.
CPT Code 9944211-20 minutes of medical discussion
CPT Code 9944321-30 minutes of medical discussion
Currently covered by Medicare and some Medicaid programs on an interim basis*
E-VisitsDescription of Service
99421 – 99423 Online digital evaluation and management service, for an established patient, for up to 7 days, a cumulative time during the 7 days
G2061 – G2063Online assessment by qualified non-physician healthcare professional
Interprofessional Telephone/Internet/EHR ConsultationsDescription of Service
99446 – 99449Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified healthcare professional
*Each code includes time for medical consultative discussion and review
99451Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time
99452Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/ requesting physician or other qualified healthcare professional, 30 minutes

HCPCS LEVEL II CODES

HCPCS Level II codes for telemedicine services are also available for reference.

HCPCS Level II Telehealth CodesService
G0406-G0408Follow-up Inpatient Consultation via Telehealth
G0425-G0427Telehealth Consultation, Emergency Department
G0508, G0509Telehealth Consultation, Critical Care
Note: CPT Copyright 2021 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.

On the CMS website, you can find a list of all the available codes for telehealth services.

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What to Expect from New Pain Management Coding Updates and Guidelines 2022 May 3, 2022

pain management cpt code

The ability to understand medical terminology has always been an essential requirement for medical coders. To better understand the language of the new codes, they should review anatomy and physiology terms.

Troubleshooting is another important recommendation for ICD-10-compatible software and computer formats. This knowledge will assist healthcare providers in resolving any technical problems in time. Thus, healthcare providers must be aware of the potential impact of coding system changes on existing and new insurance programs.

In this article, we’ll find out what to expect from new pain management coding updates and guidelines 2022.

Pain Management Coding Updates 2022

As of 2022, two CPT codes have been deleted and replaced with new ones that provide more detail about procedures.

01935— (Anesthesia for percutaneous image guided procedures on the spine and spinal cord; diagnostic)
01936—(Anesthesia for percutaneous image guided procedures on the spine and spinal cord; therapeutic) are deleted in CPT®2022.

Moreover, the new codes 01937-01942 identify the type of surgical procedure performed under anesthesia and whether it’s done on the cervical, thoracic or lumbar spines.

New CPT codes for 2022

In the table below, you can refer to the  new CPT code changes for 2022 applicable to anesthesia and pain medicine:

01937Anesthesia for percutaneous image-guided injection, drainage, or aspiration procedures on the spine or spinal cord; cervical or thoracic
01938Anesthesia for percutaneous image-guided injection, drainage, or aspiration procedures on the spine or spinal cord; lumbar or sacral
01939Anesthesia for percutaneous image-guided destruction procedures by a neurolytic agent on the spine or spinal cord; cervical or thoracic
01940Anesthesia for percutaneous image-guided destruction procedures by a neurolytic agent on the spine or spinal cord; lumbar or sacral
01941Anesthesia for percutaneous image-guided neuromodulation or intravertebral procedures (eg, kyphoplasty, vertebroplasty) on the spine or spinal cord; cervical or thoracic
01942Anesthesia for percutaneous image-guided neuromodulation or intravertebral procedures (eg, kyphoplasty, vertebroplasty) on the spine or spinal cord; lumbar or sacral
64628Thermal destruction of the intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral
64629Thermal destruction of the intraosseous basivertebral nerve, including all imaging guidance; each additional vertebral body, lumbar or sacral (List separately in addition to code for primary procedure)
933193D echocardiographic imaging and postprocessing during transesophageal echocardiography, or transthoracic echocardiography for congenital cardiac anomalies, for the assessment of cardiac structure(s) (eg, cardiac chambers and valves, left atrial appendage, interatrial septum, interventricular septum) and function, when performed (List separately in addition to code for echocardiographic imaging)
These codes and other information you need to know for coding/billing in 2022 are copyrighted by American Medical Association.

Likewise, we’ll discuss some other commonly used pain management CPT codes. These include acupuncture, dry needling,  and radiofrequency ablation.

Acupuncture

In accordance with NCD 30.3.3, Medicare now covers all types of acupuncture as a treatment for lower back pain. Patients with chronic lower back pain can receive acupuncture treatment for up to 12 sessions within a 90-day period through Medicare.

The purpose of acupuncture is to relieve pain and restore energy flow by inserting tiny needles through the skin. According to the National Center for Complementary and Integrative Health Trusted Source, acupuncture effectively treats back pain, osteoarthritis, and knee pain. Furthermore, it stimulates the body’s natural healing processes and promotes health and happiness.

Acupuncture CPT Codes

97810— Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97811—Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles
97813—Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97814—Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles

Acupuncture data is reported based on 15-minute increments of personal contact (face-to-face) with the patient, not on the intensity or duration of the acupuncture treatment.

  • When electrical stimulation is not used during a 15-minute increment, report CPT codes 97810 or 97811.
  • Electrical stimulation of any needle during a 15-minute increment are reported by using CPT codes 97813 or 97814.
  • For each 15-minute increment, you should report only one code
  • Use CPT code 97810 or 97813 for the initial 15-minute increment
  • Each day you should only report one initial code

Dry Needling

The following CPT codes are used for dry needling, which is also known as trigger point acupuncture.

20560—(Needle insertion(s) without injection(s); 1 or 2 muscle(s)
20561—(Needle insertion(s) without injection(s); 3 or more muscles)
20551—Origin or insertion of a tendon is injected
20550—Injection of the tendon sheath

The Current Procedural Terminology specifies that CPT codes 20552 or 20553 (trigger point injections) must not be reported with CPT codes 20560 or 20561 for the same muscle group.

Radiofrequency Ablation

The radiofrequency ablation (RFA) procedure involves delivering an electric current to a small nerve tissue area to prevent pain signals from being transmitted through that area. It can relieve chronic pain, specifically in the lower back, neck, and arthritic joints. 

These are the RFA CPT codes 2022:

64625— Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)
64999—Unlisted procedure, nervous system
  • If radiofrequency ablation is used with traditional or cooled radiofrequency (80 degrees Celsius), report it with CPT code 64625.
  • Report pulsed radiofrequency ablation by using CPT code 64999.

CPT Code Changes for Important Diagnoses

  • C56.3 Malignant neoplasm of bilateral ovaries (previously only left, right, unspecified existed)
  • C79.63 Secondary malignant neoplasm of bilateral ovaries (previously only left, right, unspecified existed)
  • G44.86 Cervicogenic headache
  • K22.81 Esophageal polyp
  • K22.82 Esophagogastric junction polyp
  • K22.89 Other specified diseases of esophagus (previously codes as K22.8, 5th character added)
  • K31.A—Gastric intestinal metaplasia (code to appropriate 6th character)
  • L24.A- Irritant contact dermatitis due to friction or contact with body fluids (code to appropriate 5th character)
  • L24.B- Irritant contact dermatitis related to stoma or fistula (code to appropriate 5th character)
  • M54.A- Non-radiographic axial spondyloarthritis (code to appropriate 5th character)
  • M54.50 Low back pain, unspecified
  • M54.51 Vertebrogenic low back pain
  • M54.59 Other low back pain

Any ambulatory surgical centers performing pain management procedures need to be aware of these low back pain diagnosis changes. In order to avoid an unspecified diagnosis, surgeons must understand how the revisions affect their documentation. They must be as specific as possible about the type of low back pain treated.

Tap Into Our Expertise

Medical coders might face some new challenges in light of the new pain management billing codes and guidelines. As a result, healthcare providers should evaluate how medical coding changes will affect their programs and take steps to ensure a smooth transition.

At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.

Schedule a call with our experts today!


Podiatry CPT Coding Updates for 2022 April 27, 2022

podiatry cpt coding

Every year, the American Medical Association releases a new Current Procedural Terminology set that takes effect on January 1.

Most of this year’s changes come from new guidance language rather than code additions, deletions, or edits for podiatry practices. Let’s first define podiatry care in detail before moving on to the CPT updates.

The Role of Podiatry in Healthcare

The field of podiatry deals with the diagnosis and treatment of diseases, injuries, and deformities of the foot. It involves the diagnosis, medical, and surgical treatment of the foot, ankle, and lower extremity problems. In addition to medical and surgical treatments, mechanical and physical therapies are also available. Like other disciplines, podiatry requires regular collections to survive.

On the other hand, coding is complex in podiatry due to multiple procedures performed on the same structure or organ, requiring various codes.

The Current Procedural Terminology adds the following clarification for 2022: “All services that appear in the Musculoskeletal System section include the application and removal of the first cast, splint, or traction device when performed. Supplies may be reported separately.” 

Several third-party payers, such as Medicare, have long followed this guidance, which applies everywhere CPT codes are used, regardless of the payer.

This guidance does not change based on where you receive your services. If the triple arthrodesis is performed in the operating room, the CPT code representing the cast application should not be submitted.

Similarly, suppose any fracture care code is submitted in an office setting, such as closed fracture treatment without manipulation. In that case, the CPT code corresponding to the cast application should not be submitted.

Podiatrists managing fractures often have to decide whether to perform closed treatment with manipulation or closed treatment without manipulation CPT codes.

The new language in the 2022 CPT code set clarifies what “manipulation” actually means when used in code descriptors in CPT. Manipulation is defined as: “reduction by the application of manually applied forces or traction to achieve satisfactory alignment of the fracture or dislocation.” Usually, this is referred to as closed reduction.

The CPT clarified the following codes for external fixation this year:

“Codes for external fixation are reported separately only when external fixation is not listed in the code descriptor as inherent to the procedure.”

Therefore, providers can only submit external fixation CPT codes. CPT does not include the application of external fixation in its code descriptor for the primary procedure.

Below is the CPT code corresponding to a first metatarsophalangeal joint arthrodesis:

CPT 28750Arthrodesis, great toe; metatarsophalangeal joint

Code descriptor doesn’t include external fixation in the list. Hence, the CPT code for the first metatarsophalangeal joint arthrodesis and the CPT code for the external fixation can both be submitted if external fixation is used. 

In the case of an open reduction and internal fixation (ORIF) of a metatarsal fracture that is fixed with external fixation, the CPT code for the external fixation would be:  

CPT 28485Open treatment of metatarsal fracture, with or without internal or external fixation, each

This is listed in the code descriptor. Thus, if external fixation is used with this procedure, only the ORIF CPT code can be submitted; the external fixation CPT code cannot be submitted as well.  

Foreign Body vs Implant 

If a joint prosthesis becomes loose or isn’t functioning, is it considered a foreign body removal? The CPT clearly answers this question that has been asked for a while now. 

According to the new language on page 525 of the CPT book for 2022, it states that:  

 “An object intentionally placed by a physician or other qualified health care professional for any purpose (eg, diagnostic or therapeutic) is considered an implant.”

“An object that is unintentionally placed (eg, trauma or ingestion) is considered a foreign body.”

“If an implant (or part thereof) has moved from its original position or is structurally broken and no longer serves its intended purpose or presents a hazard to the patient, it qualifies as a foreign body for coding purposes, unless CPT coding instructions direct otherwise or a specific CPT code exists to describe the removal of that broken/moved implant.”

Wound Repair

This year, a new language adds that only one CPT code is required to represent the closure of one wound when multiple products and/or multiple techniques are used to close it. 

Further information on wound repair is provided in the 2022 CPT book, on page 106, where it is stated that wounds treated with chemical cauterization, electrocauterization, or adhesive strips cannot be coded with wound repair CPT codes.

Clarification of simple wound repair is on the list this year:

“Simple repair is used when the wound is superficial (eg, involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures) and requires simple one-layer closure.”

Moreover, anesthesia and hemostasis should not be reported separately when combined to treat simple wounds.

Key Takeaway

These are just a few changes relevant to podiatrist practices in 2022’s CPT codes. The podiatry providers who submit CPT codes should know the entire CPT code set or use experts who are familiar with it. From January 1, 2022, they should utilize the most current CPT code set.  

The CPT is a trademark of and copyright (2021) of the American Medical Association, with all rights reserved. 

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What CPT Codes Mean for Medical Billing January 31, 2022

CPT codes

The Current Procedural Terminology (CPT) codes play a vital role in the medical billing process. The CPT functions as descriptions of the services provided. New CPT codes are added for everything a certified health care provider can do each year.

So, we will discuss what CPT codes mean for medical billing here.

Understanding CPT Codes in Medical Coding and Billing

Current Procedural Terminology (CPT) is a standard code set for reporting medical, surgical, and diagnostic procedures to healthcare providers, insurers, and organizations. In addition to this, CPT codes function in a multitude of ways in the medical field, such as

  • Setting guidelines for clinical care reviews and processing claims.
  • Documenting medical services and treatments provided to patients.
  • Providing an insurance company with the procedures the doctor wants reimbursement for.
  • Incorporating ICD codes into the medical processes provides payers with a complete picture of the operations.
  • Identifying the tasks and services that health care providers offer.
  • Tracking and billing of medical services.
  • A worldwide coding system for medical treatments.

The American Medical Association (AMA) streamlines the CPT manual every year. It also contains extensive requirements for service and procedure coding. Thus, providers are responsible for accurate reporting and documentation of the services.

A Brief Overview of CPT’s History

The American Medical Association manages CPT. In 1966, the AMA published the first edition of its manual of surgical procedures. At the time, terminology and reporting were standardized. 

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 set guidelines for transmitting and storing electronic health records. Also, these codes are required for coding medical terms and billing insurance companies. They provide information about the purpose of the CPT code treatment.

The Three Categories of CPT Codes

Depending on the category, CPT codes can be numeric or alphanumeric. Using CPT code descriptors, diverse users can understand clinical health care and use common standards.

Category 1: Medical procedures and practices

The first category covers widely performed procedures and medical practices. When coders talk about CPT, the Category 1 codes refer to FDA-approved services and procedures performed by healthcare providers nationwide. They are five-digit numeric codes that are proven and documented.

Six sections make up Category 1 codes, like:

  • Evaluation and Management: 99201 – 99499
  • Anesthesia: 00100 – 01999; 99100 – 99140
  • Surgery: 10021 – 69990
  • Radiology: 70010 – 79999 
  • Pathology and Laboratory: 80047 – 89398
  • Medicine: 90281 – 99199; 99500 – 99607

Category 2: Services for Clinical Laboratories

Category 2 CPT codes provide supplementary tracking codes used for performance measurement. Moreover, these codes describe the quality of care your patients receive. However, medical codes are optional and do not replace Category 1 codes.

Category III: Innovative Technologies, Services, and Procedures

Category III codes are temporary Alphanumeric codes for developing technologies, procedures, and services. These codes were created to collect, assess, and in some cases, pay for new services and processes that don’t meet the criteria for Category I codes.

What Are the Uses of Cpt Codes?

Patient costs are directly related to CPT codes. Due to this, offices, hospitals, and other medical facilities are extremely strict about coding. These facilities usually hire professionals to code services correctly.

The initial stage of coding

In most cases, the coding process will begin with your healthcare provider. They will list the CPT codes on paper forms for your visit. Likewise, you will receive a note in your Electronic Health Record (EHR) if they use one during your stay. Staff can often search for codes by service name.  

Validation and Submission

Billers and medical coders look at your records after you leave the office. Indeed, these professionals ensure the correct codes for your records.

After all, your billing department sends a list of services to your insurance company. Medical providers often store and transmit this information electronically.

Processing of Claims

Your insurer or payer processes the claim using the codes. In this case, they decide how much to pay your healthcare provider and owe anything.

Research Purposes

In fact, data coding helps insurance companies and government officials predict future patient healthcare costs. Analyzing data coding by state and federal governments can provide insight into medical trends. It also assists with planning and budgeting for Medicare and Medicaid.

These are the CPT codes commonly used in medical billing and coding processes:

  • New Patient Office Visit Codes: 99201-05. These codes apply to patients who have not seen physicians within the same group in the past three years.
  • Established Patient Office Visit Codes: 99211-15. Patients are seen by a physician in the same specialty within the same group in the past three years;
  • Initial Hospital Care Codes: 99221-23
  • Subsequent Hospital Care Codes: 99231-23
  • Emergency Department Visit Codes: 99281-85
  • Office consultation codes: 99241-45. Often used to obtain a physician’s opinion on behalf of another physician.

Furthermore, the AMA has a complete list of medical billing codes here.

Summary

Medical providers submit claims for payment using CPT codes, which the AMA maintains. Therefore, following CPT process recommendations benefits physicians (and their patients).

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At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.

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