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Changes in CPT Codes in 2021

cpt codes for 2021 March 1, 2021

The 2021 Current Procedural Terminology (CPT®) code set was released earlier last fall by the American Medical Association (AMA). There are 329 editorial changes, including 206 new codes, 54 deletions, 69 revisions, along with the “first massive revamp of office codes and guidelines and other outpatient assessment and management (E/M) services in more than 25 years.” Changes became effective earlier this year, last January 1, 2021. Here are some highlights about the changes that you should know:

E/M Services

The office and outpatient E/M Services have the biggest changes. According to the AMA, these modifications include:

  • History and physical exams are no longer an element for code selection.
  • Letting physicians choose the best patient care by permitting code level selection according to the medical decision-making (MDM) or total time.
  • Promoting payer consistency with more detail added to CPT code descriptors and guidelines.

The new CPT standards retain 5 coding levels for established patients and decrease the number of levels to 4 for new patients’ office/outpatient E/M visits. The AMA RVS Update Committee (RUC) also amended the values for the office/outpatient E/M visit codes, which will raise Medicare and possibly other payers’ payments for these services.

According to AMA President Susan R. Bailey, M.D., health care organizations need to understand and be ready to use the revisions to get the full benefit of the burden relief from the E/M office visit changes. She also adds that the AMA will help physicians and health care organizations with the transition and offers resources to understand the operational, infrastructural, and administrative workflow adjustments that will result from the pending transition.

The 2021 code set also represents the continuing pandemic of COVID-19 that devastated the globe in 2020. In the 2021 CPT code set, the following SARS-CoV-2 based CPT codes were accepted and officially issued, although some have been in use since earlier this year.

  • 87635: Added to report infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique. (Effective March 13, 2020.)
  • 86318: Revised to report immunoassay for infectious agent antibody(ies) and to be a parent to 86328. (Effective April 10, 2020.)
  • 86328: Added to report single-step antibody testing for severe acute respiratory syndrome coronavirus 2. (Effective April 10, 2020.)
  • 86769: Added as a child code to report multiple-step antibody testing for severe acute respiratory syndrome coronavirus 2. (Effective April 10, 2020.)
  • 0202U: Added to report the BioFire® Respiratory Panel 2.1 (RP2.1) test. (Effective May 20, 2020.)
  • 87426: Added to report infectious agent antigen detection by immunoassay technique of SARS-CoV and SARS-CoV-2.
    • PLA codes 0223U and 0224U: Added for detection of SARS-CoV-2.
  • 86408-86409: Added for reporting coronavirus 2 (SARS-CoV-2) neutralizing antibody screen and titer. (Effective Aug. 10, 2020.)
    • PLA codes 0225U and 0226U: Added for detection of SARS-CoV-2. (Effective Aug. 10, 2020.)
  • 99072: Added for the additional supplies and clinical staff time required to mitigate transmission of respiratory infectious disease while providing evaluation, treatment, or procedural services during a public health emergency, as defined by law. 
  • 86413: Added for reporting quantitative antibody detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
  • 87636: Added for reporting combined respiratory virus multiplex testing for either SARS-CoV-2 with Influenza A&B.
    • PLA codes 0240U and 0241U: Added for detection of SARS-CoV-2, Influenza A, and Influenza B.
  • 87637: Added for reporting combined respiratory virus multiplex testing for either SARS-CoV-2 with Influenza A&B and RSV.
    • PLA code 0241U: Added for detection of RSV.
  • 87811: Added for antigen detection of SARS-CoV-2 by direct optical (i.e., visual) observation.  
  • 87301, 87802, and their subsidiary codes: Revised immunology guidelines.
  • Accepted addition of code 87428 for reporting multiplex viral pathogen panel using antigen immunoassay technique for SARS-CoV-2 testing along with influenza A and influenza B.
  • 91300, 91301: Added to report Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccines.
    • 0001A, 0002A, 0011A, 0012A: Added to report the immunization administration of these vaccines

Prolonged Services

A few new codes, including direct and indirect medical interaction given in varied settings beyond normal assessment and management services, have been applied to the bill for prolonged services.

  • Direct Patient Contact – Outpatient

Codes 99354-99357 are utilized where long-term treatment requiring direct patient interaction is given by a physician or other trained healthcare provider and is provided in either the inpatient, observation or outpatient area (not including office or other outpatient E/M services) beyond the normal service.

99354-99355 is used to document on a given date the average amount of face-to-face time spent by a doctor or other trained healthcare provider delivering extended outpatient service. 

The first hour of prolonged service is recorded using 99354. And if the time spent is not constant, it can be used only once per date, per venue. If prolonged service is given for more than one hour, 99355 is used to record every additional 30 minutes after the first hour.

Prolonged service with a cumulative length of fewer than 30 minutes on a specified date is not recorded separately. Prolonged service of fewer than 15 minutes after the first hour or less than 15 minutes after the last 30 minutes is often not separately recorded.

  • Direct Patient Contact – Inpatient

Codes 99356-99357 are used to document the cumulative amount of time spent in the hospital or nursing home by a physician or other trained health care provider offering prolonged treatment to a patient at the bedside and on the floor or unit of the patient.

The first hour of extended service is recorded using 99356. And if the time spent is not constant, it can be used only once per date, per venue. If extended service is given for more than one hour, 99357 is used to record every additional 30 minutes after the first hour.

Prolonged service with a cumulative length of fewer than 30 minutes on a specified date is not recorded separately. Furthermore, prolonged service of fewer than 15 minutes after the first hour or less than 15 minutes after the last 30 minutes is not separately recorded.

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