CPT code changes are released annually. Anticipated CPT code updates are announced in advance, prompting physicians and providers of medical coding services to prepare for them. The Editorial Panel of the American Medical Association (AMA) has proposed several changes in the 2022 CPT code set.

Anticipated Changes For E/M Codes

In 2021, notable changes were made to E/M coding by the AMA and the Centers for Medicaid and Medicare Services (CMS). The goal to the ongoing E/M code updates, according to the AMA, is to better capture the routine codes that physicians use, while removing the codes that are rarely used. Here are the highlights of the proposed changes to E/M coding as discussed in an ICD-10 Monitor article published March 2021:

  • Inpatient and Observation Services: Hospital observation codes 99217-99226 may be deleted and the descriptors enhanced for the initial and subsequent inpatient codes, 99221-99223 and 99231-99233, for observation hospital E&M services. According to the ICD-10 Monitor article, “this change may be more favorable to the physician than the facility coding piece, as a change in definition from observation to inpatient could affect reimbursement, from Outpatient Prospective Payment System (OPPS) capitated claims to per-diem hospital reimbursement”. It is expected that this change will come into effect on Jan 1, 2023.
  • Consultation Services, Inpatient and Outpatient: Codes 99251 and 99241 are considered seldom-reported Level 1 services, and in keeping with this, it is proposed to delete these codes by 2023. In 2021, Code 99201, Level 1 new patient office visit was deleted as it was rarely reported.
  • Home Health and Residence E&M Encounters: As home health, domiciliary care, rest home, and assisted living care seem to have many many repetitive or similar codes, it is proposed to bring all these services under a single tabbed section for home health services. This is expected to be approved for revision by Jan. 1, 2023.
  • Prolonged Services: Prolonged service code 99417 was added in 2021 to specifically report office or other outpatient E/M services. It is expected that 99417 will be revised to include non-face-to-face time on the same date, and improve accuracy when used along with codes 99205 or 99215, Level 5 Office or Other Outpatient Visits. ICD-10 Monitor reports that this update would take effect by January 2023 or even by 2022. Another proposal is to delete the existing prolonged services codes 99354-99357 as they may not be reported in addition to office-based E/M services 99202-99215 in 2021.
  • Emergency Department: Codes 99281-99285 for reporting E/M services in the ED are also expected to see changes in the code descriptor.

Anticipated Changes For Radiology

The American College of Radiology (ACR) has announced that several new codes will be added in 2022. The CPT 2022 code set will have the following new Category I codes

  • Category I radiology diagnostic codes will be effective January 1, 2022.
  • Diagnostic Radiology: Four codes will be added for reporting Trabecular Bone Score (TBS). TBS an innovative tool used in the evaluation of osteoporosis. TBS uses standard lumbar spine DXA imaging to evaluate bone texture inhomogeneity and predict the risk of major osteoporotic fracture independent of bone mineral density (BMD) and clinical risk factors.
  • Diagnostic Radiology: Two new codes will be introduced to report thermal destruction of the intraosseous basivertebral nerve. This new procedure is an effective option for relief from certain types of chronic low-back pain.
  • In addition to trabecular bone score (TBS), there will be new Category I and Category III codes in 2022 to report trabecular bone score (TBS); thermal destruction of the intraosseous basivertebral nerve; quantitative ultra¬sound tissue characterization (non-elastographic); and artificial intelligence (AI) analysis for detection of vertebral fractures.

Physicians need to prepare for these changes by reviewing them and considering how the new code updates may impact their practice. Outsourced medical billing and coding services can be of great assistance in this regard.