The Centers for Medicare and Medicaid Services (CMS) officially released the fiscal year 2022 ICD-10-CM diagnosis code update on June 24, 2021. These coding updates are effective for discharges and encounters on or after October 1, 2021 through September 30, 2022. This update brings 159 additions, 25 deletions, and 27 revisions. ICD-10-CM codes for 2022 are to be used on claims from October 1, 2021 onwards. Being an experienced medical billing and coding company, we’re up to date with these changing code sets. An AAPC blog provides an overview of the coding updates, which include
CHAPTER 1 Certain Infectious and Parasitic Diseases (A00-B99)
A79.82 Anaplasmosis [A. phagocytophilum]
CHAPTER 2 Neoplasms (C00-D49)
Added are two codes to capture bilateral ovarian malignancies, allowing classification as malignant or secondary malignant neoplasm. Another addition to the code set is
C84.7A Anaplastic large cell lymphoma, ALK-negative, breast
CHAPTER 3 Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism (D50-D89)
Five new codes are added to this chapter.
D55.2 Anemia due to disorders of glycolytic enzymes
D55.21 Anemia due to pyruvate kinase deficiency and
D55.29 Anemia due to other disorders of glycolytic enzymes
Other changes include the addition of codes
D75.83 Thrombocytosis
D75.838 Other thrombocytosis (including secondary and reactive) and
D75.839 Thrombocytosis, unspecified under new subcategory
D89.44 Hereditary alpha tryptasemia
CHAPTER 4 Endocrine, Nutritional and Metabolic Diseases (E00-E89)
E75.24 Niemann-Pick disease
E75.244 Niemann-Pick disease type A/B
CHAPTER 5 Mental, Behavioral and Neurodevelopmental Disorders (F01-F99)
F32 Depressive episode
F32.A Depression, unspecified under revised category
F78.A- Other genetic related intellectual disabilities
F78.A1 SYNGAP1-related intellectual disability
F78.A9 Other genetic related intellectual disability under new subcategory
CHAPTER 6 Diseases of the Nervous System (G00-G99)
10 new codes are added in this chapter:
G04.82 Acute flaccid myelitis
G44.86 Cervicogenic headache
Six codes are added under the new subcategory G92.0 to classify immune effector cell-associated neurotoxicity syndrome by grade.
K31.A11 Gastric intestinal metaplasia without dysplasia, involving the antrum
K31.A12 Gastric intestinal metaplasia without dysplasia, involving the body (corpus)
K31.A13 Gastric intestinal metaplasia without dysplasia, involving the fundus
K31.A14 Gastric intestinal metaplasia without dysplasia, involving the cardia
K31.A15 Gastric intestinal metaplasia without dysplasia, involving multiple sites
K31.A19 Gastric intestinal metaplasia without dysplasia, unspecified site
K31.A21 Gastric intestinal metaplasia with low grade dysplasia
K31.A22 Gastric intestinal metaplasia with high grade dysplasia
K31.A29 Gastric intestinal metaplasia with dysplasia, unspecified
Three new codes have been added to classify esophageal diseases:
K22.81 Esophageal polyp
K22.82 Esophagogastric junction polyp
K22.89 Other specified disease of esophagus (hemorrhage of the esophagus NOS)
Coding tip – To determine the correct code among the new codes, coders need to check for documentation of the location involved and the presence of dysplasia.
CHAPTER 12 Diseases of the Skin and Subcutaneous Tissue (L00-L99)
Eight new codes are added under two new subcategories for irritant contact dermatitis:
L24.A – Irritant contact dermatitis due to friction or contact with body fluids
L24.A0- Irritant contact dermatitis due to friction or contact with body fluids, unspecified
L24.A1 Irritant contact dermatitis due to saliva
L24.A2 Irritant contact dermatitis due to fecal, urinary or dual incontinence
L24.A9 Irritant contact dermatitis due to friction or contact with other specified body fluids
L24.B- Irritant contact dermatitis related to stoma or fistula
L24.B0 – Irritant contact dermatitis related to unspecified stoma or fistula
L24.B1 – Irritant contact dermatitis related to digestive stoma or fistula
L24.B2 – Irritant contact dermatitis related to respiratory stoma or fistula
L24.B3 Irritant contact dermatitis related to fecal or urinary stoma or fistula
CHAPTER 13 Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)
Three codes are added under subcategory M31.1 to report hematopoietic stem cell transplant-associated thrombotic microangiopathy. The code set adds a Use Additional note after code M31.11, instructing you to also code for the specific organ dysfunction.
M35.0 Sjogren syndrome (seven codes are added for identification of associated diseases or conditions)
M35.05 Sjogren syndrome with inflammatory arthritis
M35.06 Sjogren syndrome with peripheral nervous system involvement
M35.07 Sjogren syndrome with central nervous system involvement
M35.08 Sjogren syndrome with gastrointestinal involvement
M35.0A Sjogren syndrome with glomerular disease
M35.0B Sjogren syndrome with vasculitis
M35.0C Sjogren syndrome with dental involvement
New subcategory added is
M45.A Non-radiographic axial spondyloarthritis
10 new codes are added for non-radiographic axial spondyloarthritis, which allows classification based on the affected region of the spine.
M54.5, the code for Low back pain is expanded with the addition of three codes
M54.50 Low back pain, unspecified
M54.51 Vertebrogenic low back pain, and
M54.59 Other low back pain
CHAPTER 16 Certain Conditions Originating in the Perinatal Period (P00-P96)
Nine new codes are added –
one code for newborn affected by maternal group B Streptococcus colonization and
eight codes to capture specific abnormal findings on neonatal screening
CHAPTER 17 Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00-Q99)
“Nephronopthisis” is revised to “Nephronophthisis” under code Q61.5 Medullary cystic kidney.
CHAPTER 18 Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99)
14 codes are added to this Chapter.
Major additions include
R45.88 Nonsuicidal self-harm, and
R79.83 Abnormal findings of blood amino-acid level
R63.30 Feeding difficulties, unspecified
R63.31 Pediatric feeding disorder, acute
R63.32 Pediatric feeding disorder, chronic
R63.39 Other feeding difficulties (feeding problem (elderly) (infant) NOS, picky eater)
CHAPTER 19 Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88)
Six codes are added to differentiate traumatic brain compression with or without herniation under new subcategory –
S06.A- Traumatic brain compression and herniation
36 new codes are added to classify poisoning, adverse effect, and underdosing of cannabis and synthetic cannabinoids under new subcategories –
T40.71 Cannabis (derivatives), and
T40.72 Synthetic cannabinoids
These codes replace deleted subcategory T40.7X- Cannabis (derivatives) and all of the codes classified under it.
CHAPTER 21 Factors Influencing Health Status and Contact with Health Services (Z00-Z99)
19 new codes are introduced and many updates are related to social determinants of health:
Code additions include
Z55.5 Less than High School Diploma
Z58.6 Inadequate drinking-water supply
Z71.85 Encounter for immunization safety counseling
Z91.014 Allergy to mammalian meats
Code expansions include
Z59.0- Homelessness to allow specification of sheltered or unsheltered
Z59.4 Lack of food is expanded to include
Z59.41 Food insecurity, and
Z59.48 Other specified lack of adequate food
Three new codes are added under Z59.81 Housing instability, housed; and Z59.89 Other problems related to housing and economic circumstances to account for foreclosure on loan, isolated dwelling, and problems with creditors.
Four codes are added under Z92.8 Personal history of other medical treatment, three under new subcategory Z92.85 Personal history of cellular therapy, including chimeric antigen receptor T-Cell Therapy (CAR-T), and Z92.86 Personal history of gene therapy.
CHAPTER 22 Codes for Special Purposes (U00-U85)
One new code is added in this chapter.
U09.9 Post COVID-19 condition, unspecified
Its Code first note instructs coders to list the code for the specific condition related to COVID-19, such as –
J96.1- Chronic respiratory failure
R43.8 Loss of smell or taste
M35.81 Multisystem inflammatory syndrome
Assignment of accurate codes is critical for medical practices to submit clean claims and thus get reimbursement on time. Companies providing medical coding services can help practices meet such coding and billing challenges.
Every year, the CPT Editorial Panel of the American Medical Association (AMA) releases new, revised and deleted codes for all specialties including radiology. Along with the annual changes, there are also quarterly updates and guidelines. As a radiology medical coding company, we stay up to date with these changes to help radiology departments and practices report services accurately. Here, we discuss the expected radiology coding changes for 2022.
In 2021, radiology witnessed several coding changes as a result of bundling mandates from the AMA. In May, the American College of Radiology (ACR) notified providers of two Category 3 CPT updates from the American Medical Association pertaining to quantitative, multi-parametric MRI. CPT codes 0648T and 0649T for this new technology came into effect on July 1.
Though the changes and revisions to radiology coding and guidelines for 2022 released by the ACR have not been finalized, radiology providers, physicians, medical coding service providers, and healthcare regulatory and compliance teams need to be aware of the updates to expect.
New Category I Radiology Codes in 2022
Category I divided describe distinct medical procedures or services furnished by QHPs. New Category I CPT codes are released annually. The radiology code set will have new Category I diagnostic codes effective Jan. 1 2022.
Diagnostic Radiology: Trabecular Bone Score (TBS): There will be 4 new codes for reporting trabecular bone score (TBS). The new CPT codes will significantly help provide better access to TBS.
About TBS: It is estimated that an osteoporotic fracture occurs every three seconds. According to the National Osteoporosis Foundation, the cost of these fractures per year in the USA is $52 billion and with the aging population, this number is expected to grow steadily. The main reason for this is that 75% of high-risk patients are not diagnosed in a timely manner. Bone mineral density (BMD) measures quantity but not quality of bone. On the other hand, TBS is a bone texture analysis related to bone micro-architecture that can improve fracture risk assessment in osteoporosis, categorize patients based on their fracture risk, and improve patient management.
Diagnostic Radiology: Destruction of Intraosseous Basivertebral Nerve: There will be 2 new codes to report thermal destruction of the intraosseous basivertebral nerve. This is a new procedure that provides effective relief for patients suffering from certain types of chronic low-back pain.
About thermal destruction of the intraosseous basivertebral nerve: Intravertebral disc degeneration is a common problem related to aging. It is a key reason for spine stiffness, neck pain, back pain, and other impairments and disability among middle aged and older individuals. Invertebral body endplate changes and degeneration (upper and low portion of the bones that make up the spine) can be seen on MRI. The basivertebral nerve that innervates the degenerated vertebral body endplates sends pain signals to the brain. Thermal destruction of the intraosseous basivertebral nerve is an advanced treatment for chronic low back pain, which has historically been a challenge to treat.
Another update is the addition of a parenthetical note to direct users to these new codes that will be added in the Percutaneous Vertebroplasty and Vertebral Augmentation subsection of the Musculoskeletal section of the CPT 2022 code set.
Radiology medical billing is complex as it is difficult to stay up-to-date on the individual payer changes and regulation changes. Outsourced medical billing companies have expert teams of certified coding and billing personnel that stay current on coding changes, payer rules, and industry developments. Partnering with a reliable radiology medical billing and coding company can help providers stay compliant, and ensure accurate claims submission and appropriate reimbursement.
With the ever-changing complexities around claims management and processing, most practices and physicians rely on medical coding and billing service providers to report services correctly and ensure appropriate reimbursement.
As of January 1, 2021, significant changes were made to the office and outpatient Evaluation and Management (E&M) services (CPT codes 99202-99215) for both new and established patients. While CPT code 99201 was deleted, CPT code 99211 (established patient, level 1) was retained as a reportable service.
CPT code 99211 denotes “Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician”. CPT further states that the presenting problem(s) are usually minimal and typically, 5 minutes are spent performing or supervising these services. A minimal problem is one that may not require the presence of the physician or other qualified health care professional, but the service is provided under the physician’s or other qualified health care professional’s supervision.
The American Medical Association states, “For office or other outpatient services, if the physician’s or other qualified health care professional’s time is spent in the supervision of clinical staff who perform the face-to-face services of the encounter, use 99211”. However, as code 99211 does not have any other specific guidelines like the other office visit codes, there is a lot of confusion regarding its use and documentation of the services rendered. Reporting 99211 correctly can improve revenue and documentation.
Recommendations for the Appropriate Use of Code 99211
Here are important recommendations for the proper use of 99211 for an office visit:
Ensure that a separate E/M service has been documented: The physician should document evaluation of the patient as well as management of the patient’s care. If the visit involved only refill of the patient’s medications by the nurse and no other E/M service was provided, 99211 should not be reported
The supervising physician or qualified health care professional must be in the office at the time of service: To assign 99211, certain payers including Medicare, require that the supervising provider is in the office suite at the time of the appointment. However, the billing provider does not have to be in the room or to provide face-to-face services for the patient.
Bill the services under the supervising provider: The supervising provider has to be present in the room but does not have to provide the service. Code 99211 must be billed as if the supervising provider personally performed the service. Documentation should specify:
the identity and credentials of the supervising physician and the staff that provided the service
the degree of the physician’s involvement
the link between the services of the two providers
Prove medical necessity: When using 99211, providers should clearly document or demonstrate that an E/M service was performed and that it was medically necessary. The documentation should support the visit and ensure that the E/M service is significant and separately identifiable from other services provided that day.
Prior to the pandemic, code 99211 could be used only for an established patient. CPT defines an established patient as one who has received professional services from the physician or another physician of the same specialty in the same group practice within the past three years. The established-patient rule also is important since Medicare applies the concept of incident-to services for 99211. Incident-to services are provided by a non-physician practitioner (e.g., RN). The provider must have initiated the service as part of a continuing plan of care, and the 99211 service provided is an incidental part of that care plan.
However, it must be noted that CMS updated their rule after the COVID-19 pandemic, noting that providers performing COVID-19 specimen collection could bill 99211 for new and established patients during the public health emergency (https://s3.amazonaws.com/cdn.smfm.org). The AMA has published a document with various scenarios when collecting COVID-19 specimens, including the use of the 99211.
When Code 99211 cannot be Billed
On their site, health insurer EmblemHealth lists specific services that cannot be reported using code 99211. Physicians and staff should not use this code to bill for:
Administering routine medications by physician or staff whether or not an injection or infusion code is submitted separately on the claim
Checking blood pressure when the information obtained does not lead to management of a condition or illness
Drawing blood for laboratory analysis or for a complete blood count panel, or when performing other diagnostic tests whether or not a claim for the venipuncture or other diagnostic study test is submitted separately
Faxing medical records
Making telephone calls to patients to report lab results or to reschedule patient procedures
Performing diagnostic or therapeutic procedures (especially when the procedure is otherwise usually not covered/not reimbursed, or payment is bundled with reimbursement for another service) whether or not the procedure code is submitted on the claim separately
Recording lab results in medical records
Reporting vaccines
Writing prescriptions (new or refill) when no other evaluation and management is needed or performed
It’s important that medical coding service providers educate clinicians about ensuring accurate documentation for appropriately reporting 99211 services. This will also ensure a more beneficial medical record for all clinicians involved in the care of the patient.
Fine Needle Aspiration (FNA) is a simple biopsy technique usually done in the breast, thyroid gland or lymph nodes in the neck, groin, or armpit. In this procedure, a thin needle is passed through the skin to obtain a sample of a fluid or tissue from a swelling or lump. Medical practices as well as medical coding companies should note that the CPT codes for FNA have been updated recently.
Check out the infographic below to learn the 2019 CPT coding changes for FNA
Nephrology medical coding involves using ICD-10, CPT as well as HCPCS codes for all conditions including Addison’s disease. Accurate codes help prevent claim denials.
A rare disorder which occurs when the outer layer of the adrenal glands gets damaged, Addison’s disease is caused by disruptions to the adrenal glands, preventing normal secretions of steroid hormones cortisol and aldosterone. Left untreated, this condition can become more severe medical emergency. As nephrology medical coding is complex and tricky, most physician practices rely on medical coding outsourcing to meet their documentation requirements.
Read the infographic below to get familiar with the ICD-10 codes for this condition.
![Fine Needle Aspiration Biopsy – 2019 CPT Code Updates [Infographics]](https://www.outsourcestrategies.com/wp-content/uploads/2019/07/osi-fine-needle-aspiration-biopsy-2019-cpt-code-updates-329708_850x675.jpg)
![ICD-10 Coding for Addison’s Disease [Infographics]](https://www.outsourcestrategies.com/wp-content/uploads/2019/05/icd10-coding-for-addisons-disease-491291_800x675.jpg)
![ICD-10 Coding for Addison's Disease [Infographics]](https://www.outsourcestrategies.com/wp-content/uploads/2019/05/icd10-coding-for-addisons-disease.jpg)