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2021 CPT & E/M Code Updates: 19 Questions & Answers

We hosted a series of webinars at the end of 2020 covering the different coding changes for 2021. This article summarizes the live questions (with answers) we received during those webinars.

1. Is HCPCS code G0297 being deleted?

Yes, HCPCS code G0297, Low dose CT scan (LDCT) for lung cancer screening, will no longer be available after December 31, 2020. The new Current Procedural Terminology (CPT®) code 71271, Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s), will be available to report.

2. For the evaluation and management (E/M) changes to codes 99201-99355, is HCPCS code G0463 still an acceptable alternate code?

Yes, HCPCS code G0463, Hospital outpatient clinic visit for assessment and management of a patient, is still the Medicare-preferred code. Although CPT® code 99201 is being deleted, facilities should still use their own internal guidelines for code selection.

Source: Federal Register Vol. 78, No. 237, Tuesday, December 10, 2013, “B. Payment for Hospital Outpatient Clinic and Emergency Department Visits,” page 75038

3. For lab codes, when do we use the Proprietary Laboratory Analyses (PLA) codes versus the Tier 1 or Tier II codes?

When a PLA code is available to report a given proprietary laboratory service, that PLA code takes precedence. Reporting the PLA code is restricted to the specific proprietary laboratory test and is always performed by a specific laboratory. Otherwise, the appropriate CPT® Category I code, which may be a Tier I or Tier II code, should be reported.

Source: CPT® Assistant, August 2018, “Reporting Proprietary Laboratory Analyses (PLA) Codes”

4. Can new CPT® code 0631T be used for a transcutaneous oximetry (TCOM) service prior to hyperbaric oxygen (HBO) therapy?

The use of CPT® code 0631T, Transcutaneous visible light hyperspectral imaging measurement of oxyhemoglobin, deoxyhemoglobin, and tissue oxygenation, with interpretation and report, per extremity, is performed to obtain tissue oxygenation measurements to identify areas of reduced blood flow and ischemic tissue in an extremity. It is possible that this may be used, as long as an interpretation and report is performed.

Source: CPT® 2021 Changes: An Insider’s View, page 225

5. Is the Level 1 CPT® code for E/M services being deleted?

Yes, CPT® code 99201, Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family, is being deleted after December 31, 2020. The American Medical Association (AMA) suggests CPT® code 99202, Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter, as a replacement. The AMA stated that a new patient would require a higher level of medical decision making (MDM), and deletion of 99201 would mean that the MDM for new and established patients would have four levels.

6. If a facility is not performing the interpretation and report, would they be able to report the new code 92653?

Yes, CPT® code 92653, Auditory evoked potentials; neurodiagnostic, with interpretation and report, is assigned to status indicator S, Procedure or Service, Not Discounted When Multiple, and is assigned to Ambulatory Payment Classification 5722, Level 2 Diagnostic Tests and Related Services. The National Payment Rate (NPR) is $264.45. This payment is for the technical portion provided by the facility. The physician’s professional claim will reimburse for the professional component of the interpretation and report.

Source: Publication 100-04 Medicare Claims Processing Manual, Chapter 3 Inpatient Hospital Billing, Subsection 10.1 Claim Formats, page 11

7. How do the new drug testing codes affect the G0480-G0483 definitive drug tests?

The new drug assay codes 80143-80210 are therapeutic drug assays and are used to monitor levels of a known, prescribed, or over-the-counter medication. These tests are therapeutic assays and include immunoassays. These types of tests are excluded from the definitive drug testing definition. Definitive drug identification methods include gas, chromatography with mass spectrometry and liquid chromatography mass spectrometry.

Source: AHA Coding Clinic® for HCPCS, 2018Q1, Drug Classes

8. Are new HCPCS codes G2211 and G2212 chargeable/reportable on the hospital billing side?

HCPCS codes G2211, Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established), and G2212, Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99205, 99215 for office or other outpatient evaluation and management services) (do not report G2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416). (do not report G2212 for any time unit less than 15 minutes), are both assigned to status indicator N, Items and Services Packaged into APC Rates. The codes are reportable, but the reimbursement will be packaged into the reimbursement for the primary E/M service.

9. Our hospital labs are concerned with differentiating the new acetaminophen, salicylate and blood alcohol codes with the definitive drug codes. The ED typically orders those tests when they don't know what the patient may or may not have taken and they might periodically check levels until they come down. They indicate this will create challenges to ordering correctly. Do you have recommendations?

The new codes for acetaminophen, salicylate, and blood alcohol represent therapeutic drug assays that are performed to monitor levels of a known, prescribed, or over-the-counter medication. Definitive drug identification methods include gas, chromatography with mass spectrometry and liquid chromatography mass spectrometry.

There has been no change to the definitive drug testing codes. Therefore, it would be recommended that presumptive and/or definitive drug class testing be performed initially to determine which substances the patient may have ingested. Once the specific substances are known, then therapeutic drug assay codes should be used to recheck levels.

Source: CPT® 2021 Manual, Professional Edition, page 594 and 586-589

10. Is CPT® code 19370 used in addition to or in place of CPT® code 11970?

CPT® code 11970, Replacement of tissue expander with permanent implant, does include minor revisions to the breast capsule. CPT® code 19370, Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy, may be reported in addition to CPT® 11970 if a more extensive capsular revision is performed. There is a National Correct Coding Initiative (NCCI) edit in place, but a modifier may be appropriate.

Source: CPT® 2021 Changes: An Insider’s View, “Surgery, Breast Reconstruction”, page 68

11. Because CPT® code 32408 includes imaging guidance, how should a hospital radiology department report the radiology portion when the Operating Room (OR) is reporting their part with CPT® code 32408?

You would follow your policy for other services that are done in the OR where imaging guidance is inclusive of the procedure. Many facilities create a statistical line item in their charge description master (CDM) to capture the radiology department’s service.

12. If you have more than one lesion in different lobes or even a different lung and are doing all core biopsies, how many instances of CPT® code 32408 can you charge?

According to the CPT® Guidelines, when one or more core needle biopsies of the lung or mediastinum with imaging guidance is performed on separate lesions at the same session on the same day, CPT® 32408 may be reported once for each lesion with modifier 59, Distinct Procedural Service.

The Centers for Medicare & Medicaid Services (CMS) has not established a Medically Unlikely Edit (MUE) value for the first quarter of 2021, but that may change at a later time.

Source: CPT® 2021 Professional Manual “Surgery / Respiratory System”, page 226

13. If image guidance is not performed with CPT® code 32408, is it appropriate to report the code with a modifier or would a different CPT® code be more appropriate?

You are able to report CPT® code 32408, Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed, without a modifier for the service. Although, with guidance is the most common way the service is provided, there are instances when guidance may not be used. When guidance is used, CPT® code 32408 includes all imaging guidance regardless of the number of imaging modalities used on the same lesion during the same session.

Source: CPT® 2021 Professional Manual “Surgery / Respiratory System”, page 226

14. Is it possible to report CPT® code 10021 with CPT® code 32408 when performed on the same day?

Yes, it may be possible to report CPT® code 10021, Fine needle aspiration biopsy, without imaging guidance; first lesion, with CPT® code 32408, Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed, on the same day. The CPT® Guidelines list several coding examples on reporting, with examples of modifier application. If clinically necessary to perform a fine needle aspiration (FNA) and a core needle biopsy at the same session on the same day, modifier 59, Distinct Procedural Service, may be used.

Caution must be used, as this is an instance where guidance from CPT® and CMS is different. The National Correct Coding Policy Manual states that, “FNA biopsies shall not be reported with a biopsy procedure code for the same lesion.”

Sources: CPT® 2021 Professional Manual “Surgery / Respiratory System”, page 226 & NCCI Policy Manual for Medicare Services, Chapter 3, Section L, Subsection 12

15. For a breast augmentation with fat grafting, is the harvest of the fat inclusive to the procedure?

Yes, that is correct. The harvesting and injection of the fat into the breast are inclusive of the procedure. With the deletion of CPT® code 19324, Mammaplasty, augmentation; without prosthetic implant, CPT® guidance to report breast augmentation with fat grafting is to use codes 15771 and 15772.

The guidelines for CPT® codes 15771, Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; 50 cc or less injectate, and 15772, Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; each additional 50 cc injectate, or part thereof (List separately in addition to code for primary procedure), state, “Do not report 11950, 11951, 11952, 11954 in conjunction with 15771, 15772, 15773, 15774, for the same anatomic site.”

Sources: CPT® 2021 Professional Manual “Surgery / Integumentary System”, page 125 & CPT® 2021 Professional Manual “Surgery / Integumentary System”, page 113

16. How is HCPCS code C9745 used with the new CPT® codes 69705 and 69706?

HCPCS code C9745, Nasal endoscopy, surgical; balloon dilation of eustachian tube, is going to be deleted and is not reportable for 2021. CPT® codes 69705, Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); unilateral, and 69706, Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); bilateral, may be used in place of the deleted HCPCS code.

Source: CPT® 2021 Professional Manual “Surgery / Auditory System”, page 506

17. Is it true that CPT® code 99201 has been deleted?

Yes, CPT® code 99201, Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family, will be deleted for 2021. The suggested replacement code is 99202, Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter. The difference between the two codes was in the level of medical decision making (MDM). The CPT® Editorial Panel indicates that when a physician or nonphysician practitioner is evaluating a new patient, that the level of MDM would be at least straightforward. This makes CPT® code 99201 obsolete.

CPT® 2021 Professional Manual “Evaluation and Management / Office or Other Outpatient Services”, page 18

18. Can we code CPT® codes 45335 and 45350 together?

Yes, if both procedures were performed separately and appropriately documented, CPT® code 45335, Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance, and CPT® code 45350, Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids), represent different services that are not considered to be components of each.

19. How should we report a vaginal hysterectomy for uterus greater that 250 g after CPT® code 58293 is deleted? Would you use the unlisted code?

CPT® code 58293, Vaginal hysterectomy, for uterus greater than 250 g; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control, should only be assigned when a combination procedure involving hysterectomy and colpo-urethrocystopexy are performed at the same session through the end of CY 2020. To appropriately report these services for dates of service on or after January 1, 2021, you would select the appropriate hysterectomy code in the range of 58290-58294 and then add an appropriate code for additional repair procedures performed, such as 57289, Pereyra procedure, including anterior colporrhaphy, or 51840, Anterior vesicourethropexy, or urethropexy (eg, Marshall-Marchetti-Krantz, Burch); simple.

Resources Available On-Demand

If you need more resources regarding all the 2021 updates, all of our webinars are available on-demand. Feel free to reach out with questions or if you have a topic you'd like to see covered in an article or webinar.