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2024 CPT Code Guideline Resources December 7, 2023

cpt 2024

It’s a familiar cycle: Each year, the American Medical Association (AMA) rolls out new rules for CPT codes to keep up with new medical procedures and technology. The updates may include new codes for different healthcare services, tweak existing rules for clarity, or remove outdated ones.

With this annual update comes two main challenges—adaptation and compliance. These changes aren’t just a series of boxes you need to check; they represent the evolving landscape of healthcare delivery, where precision in medical billing impacts patient care and practice sustainability. Whether you’re a seasoned coder, physician, or practice manager, knowing these new guidelines is critical to the health of your organization.

This article guides you through the key changes in the 2024 CPT coding guidelines, underscores the importance of precise coding, and outlines practical strategies to prepare for the code revisions.

Key Changes in the 2024 CPT Coding Guidelines

The CPT 2024 guideline includes significant updates stated below:

  • Spanish Language Descriptors: There will be Spanish language descriptors for over 11,000 medical procedures and services to improve inclusivity and transparency. 
  • Editorial Changes: There are 349 editorial changes, including 230 new codes, 49 deletions, and 70 revisions, reflecting the innovations in medical science and technology​​.
  • Immunization CPT Codes Changes: AMA consolidates over 50 previous codes to streamline COVID-19 immunization reporting, along with new provisional codes (91318-91322) for Moderna and Pfizer vaccines pending FDA approval and a universal vaccine administration code (90480)​​.
  • New RSV Immunization Codes: Five new codes (90380, 90381, 90683, 90679, and 90678) have been added to the CPT code set for reporting product-specific Respiratory Syncytial Virus (RSV) immunizations. 
  • Evaluation and Management (E/M) Services: The 2024 revisions offer detailed explanations in response to inquiries from the Centers for Medicare & Medicaid Services regarding the documentation procedures for E/M services. Updates include:
    • Revisions include removing time ranges for office or other outpatient visit codes (99202-99205, 99212-99215) to standardize their structure with similar E/M codes.
    • Defining the substantive portion of split/shared E/M visits, where a doctor and a non-doctor provider collaboratively conduct all the work related to the encounter
    • Guidelines for reporting services related to hospital inpatient or observation care, as well as for admission and discharge services, particularly when employing codes 99234-99236 and the patient’s stay spans two calendar dates​ 

Why Is Precise CPT Coding Critical?

The stakes of CPT coding accuracy are high, impacting everything from the patient experience to the practice’s bottom line. Thus, proper coding is essential for your practice to achieve the following benefits:

1. Streamlined Billing and Reduced Claim Rejections

Accurate coding streamlines the billing process, which is integral to the financial health of any medical practice. It helps minimize incorrect or outdated codes, directly decreasing claim rejections and denials from insurers. This results in timely reimbursements and less costly interruptions. In addition, inaccurate coding delays payments and increases administrative burdens as staff spend time correcting and resubmitting claims.

2. Clearer Medical Documentation

Precise CPT coding also facilitates clearer medical documentation, which is vital for continuity of care. It provides a uniform language that healthcare providers can use to communicate clearly and efficiently. This aids in patient care within the same practice and across different healthcare facilities.

When each procedure is correctly coded, it paints an accurate picture of the patient’s medical history and the care they’ve received. This clarity is invaluable for subsequent providers who rely on a patient’s history to inform treatment decisions. Accurate coding and billing can protect healthcare providers from potential fines and penalties during audits or compliance reviews.

3. Better Compliance With Healthcare Policies and Regulations

When medical professionals accurately apply CPT codes, they comply with the standards set by the Centers for Medicare & Medicaid Services (CMS) and other regulatory bodies. Adherence to these regulations safeguards providers against legal repercussions from incorrect coding. The goal isn’t just to avoid penalties or audits, it’s also about providing quality healthcare and demonstrating a commitment to ethical billing practices.

4. Easier Data Collection and Analysis

When everyone uses CPT codes the same way, it can help healthcare leaders see more significant patterns in patient care. Researchers rely on accurate data to track health trends, measure outcomes, and determine the effectiveness of treatments. Precise CPT coding contributes valuable data for public health research and policy-making

The Best Ways to Prepare for CPT Coding Guidelines 2024

Preparation is crucial in adapting to the CPT 2024 code changes. Below are some strategies to smoothly catch up on code guidelines and stay ahead of the curve.

1. Always Check the Official CPT Coding Manual

The official CPT coding manual is an indispensable resource. Coding professionals must reference the manual consistently to ensure coding accuracy and compliance. The manual offers the new CPT codes and provides the context and guidelines needed for their correct application.

2. Use Technology to Your Advantage

Computer-assisted coding (CAC) software comes with up-to-date coding tools that automate many aspects of the billing process, ensuring that practices accurately use the latest AMA 2024 CPT codes. It can validate codes against current guidelines, check for billing errors in real-time, and streamline claim submission, thereby reducing denials and improving reimbursement rates.

3. Conduct Ongoing Training and Skill Development

The CPT coding guidelines are ever-evolving, and so must the skill sets of those who navigate it. Workshops, webinars, and continuous education courses are essential for medical coders to stay current with the latest practices.

4. Outsource for Expert Assistance

Outsourcing your medical billing and coding to specialists who stay abreast of the latest updates and best practices guarantees proficient handling of every aspect of the entire billing process. This results in faster coding and fewer errors, improving the turnaround time for claims submissions. It can be more cost-effective to outsource than to hire and train additional in-house staff, especially for practices facing a temporary increase in workload due to the transition to new CPT Coding Guidelines 2024.

The global medical billing outsourcing market is projected to be worth US$ 25.7 Billion by 2028. This growth indicates increasing trust and reliance on outsourcing in healthcare, suggesting its role in improving the profitability of many organizations​.

Takeaway

As we edge closer to 2024, healthcare providers must embrace technology, use guideline resources, and commit to continuous learning to navigate the complex landscape of CPT coding. By taking proactive steps to prepare for these changes, practices can position themselves for success. Accurate CPT coding leads to improved revenue cycles, better compliance, and, ultimately, enhanced patient care.

Tap Into Our Expertise 

At 5 Star 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!


The New AMA CPT Release Codes for 2022 January 7, 2022

AMA cpt codes

The American Medical Association (AMA) has released the latest version of the Current Procedure Terminology (CPT) code set for 2022.  AMA made 405 changes to the current procedure code set in 2022, including 249 new codes, 63 deletions, and 93 revisions. These changes will take effect on January 1. 

What is a CPT® code?

Current Procedural Terminology (CPT®) codes provide doctors and healthcare professionals a uniform language to code medical services and procedures to simplify reporting, improve accuracy, and increase efficiency. CPT codes are also used to manage administrative tasks like claims processing and medical care reviews. Electronic medical billing utilizes CPT codes as well as ICD-9-CM or ICD-10-CM numerical diagnostic coding. Throughout the country, CPT terminology is used to report medical, surgical, radiology, laboratory, anesthesia, genomic sequencing, evaluation, and management (EM) services under public and private health insurance programs.

The following AMA CPT codes were announced for new vaccine-specific immunizations against the novel coronavirus. 

With the help of the Centers for Disease Control and Prevention (CDC), the AMA’s CPT editorial panel approved unique immunization codes for two coronavirus vaccines — as well as administration codes unique to each vaccine. In a press release, the AMA stated that the new CPT codes differentiate each coronavirus vaccine for better tracking, reporting, and analysis for data-driven planning and allocation.

The new Category I CPT codes and long descriptors for the vaccine products are:

91300Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative-free, 30 mcg/0.3 mL dosage, diluent reconstituted, for intramuscular use 
(Report 91300 with administration codes 0001A, 0002A, 0003A, 0004A)
◄ Do not report 91300 in conjunction with administration codes 0051A, 0052A, 0053A, 0054A, 0071A, 0072A)
November 10, 2020 July 30, 2021 

September 3, 2021 
October 6, 2021 
0001A, 0002A, 91300: December 11, 2020
0003A: August 12, 2021
0004A: September 22, 2021 0071A, 0072A: October 29, 2021 0051A, 0052A, 0053A, 0054A: Effective upon receiving Emergency Use Authorization or approval from the Food and Drug Administration (FDA)
CPT® 2022/2023
91301Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative-free, 100 mcg/0.5 mL dosage, for intramuscular use 
(Report 91301 with administration codes 0011A, 0012A, 0013A) 
November 10, 2020 

August 16, 2021
0011A, 0012A, 91301: December 18, 2020 
0013A: August 12, 2021 
CPT® 2022/2023

 

Here are the new Category I CPT codes and long descriptors for vaccines:

To comply with new CPT codes for vaccine-specific products, the CPT editorial panel collaborated with the Centers for Medicare & Medicaid Services. Their purpose is to develop vaccine administration codes that are distinct for each Coronavirus vaccine and the specific dose used in the schedule.

According to AMA, the level of specificity is a first for vaccine CPT codes. However, it allows tracking all vaccine doses, even when the vaccine product is not reported, like when a vaccine may be given free to the patient. Moreover, these CPT codes report the actual act of administering the vaccine and all counseling needed to the patient or caregiver. They also update the electronic records. 

The AMA site provides a number of resources regarding the new vaccine administration CPT codes and long descriptors. As soon as each newly developed Coronavirus vaccine receives Emergency Use Authorization or FDA approval, all the new vaccine-specific CPT codes will be available for use.

AMA’s website offers short and medium descriptors for these new vaccine-specific CPT codes. They also provide recent changes to the set of CPT codes that have streamlined the public health response to SAR-CoV-2 and COVID-19 disease.

In addition to releasing the standard code descriptor PDF of SARS-CoV-2-related CPT codes, we are also providing an easy-to-use Excel file of SARS-CoV-2-related CPT codes. It contains all the SARS-CoV-2 CPT codes, some may not be included in the 2022 CPT data file, and it includes:

  • CPT code descriptors (long, medium, and short)
  • Published date
  • Effective date
  • Type of change. 

AMA will update these files as new CPT codes are approved by the CPT Editorial Panel:

Category I vaccine descriptors

Therapeutic Remote Monitoring New CPT Codes

CPT code set for 2022 includes five new codes (98975, 98976, 98977, 98980, 98981) for reporting therapeutic remote monitoring. These codes reflect the rise of digital care during the pandemic. In a news release, the AMA referred to codes 99453, 99454, 99457, and 99458 as “codes that expand upon the remote physiologic monitoring codes created in 2020.”

According to the AMA, the new code set includes a taxonomy that supports “increased awareness and understanding of approaches to patient care through diverse digital medicine services available for reporting.”

As noted by the AMA, technology continues to influence CPT code changes. In fact, 43% of the latest changes come from Category III codes or the Proprietary Laboratory Section section.

Updates to the Care Management Procedures

As of 2020, new CPT codes also apply to the principal care management program. Patients with a single chronic condition can receive reimbursement under that policy. Whereas before, only patients with multiple chronic conditions were eligible.

The AMA wrote that the new codes – 99424, 99425, 99426, 99427 – and changes to existing codes, “better align with Medicare guidelines.” Thus, a data file can be used to download the codes and descriptors into a provider’s software solution.

Tap Into Our Expertise

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!


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