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(CY) 2021 CPT® Code Set Available Now in VitalKnowledge®

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The American Medical Association (AMA) released the 2021 updates to the CPT® code set on August 31, 2020 – the updates were made available for review in VitalKnowledge® on the same day. These code changes will be effective on January 1, 2021, and are summarized below. Vitalware will be hosting future webinars to discuss these changes in more depth as we approach 2021.

Changes to the code set include 87 new codes, 46 deleted codes, and 62 codes with revised long descriptions. Please note that the revised number does not include codes with changes to the short/medium descriptions only or to codes that only have changes in spacing or non-essential punctuation. Also, changes to the 2021 code set do not Include code changes that occurred during CY 2020 that are being published In the CPT® book for the first time In 2021. For more information on code changes due to COVID-19 or quarterly code changes, please refer to our COVID-19 Coding & Billing Resource Center.

Evaluation & Management

The Evaluation and Management (E/M) section has two additions, one deletion, and 17 codes with revised descriptions. CY 2021 Is bringing significant changes to the way that providers select E/M codes. These changes have necessitated major updates to the existing code descriptors and two new add-on codes. Specifically, one new add-on code will be used to report additional physician time when outpatient clinic visits exceed the time described by CPT® codes 99205 or 99215 (99417), while the other new CPT® code has been created to allow for reporting of each additional 20 minutes of chronic care management services In a calendar month (99439). CPT® code 99201 has been deleted due to the changes In E/M code assignment; new patients seen In the outpatient clinic environment should be assigned CPT® codes 99202-99205 based upon either the amount of time spent in patient care or based upon the level of medical decision making required. CPT® codes 99202-99215 have all been revised to remove the key components and to update the time spent with the patient. Finally, the long descriptions for CPT® codes 99354, 99355, and 99356 have been revised to accommodate all of the changes to the E/M section.

Surgery

There are 11 additions, 11 deletions, and 28 description revisions to the Surgery section. There are multiple changes In the Breast Repair and/or Reconstruction subsection of the book. Changes Include the deletion of codes for breast augmentation without Implant (19324) and nonspecific breast reconstruction (19366). A total of 15 codes have revisions to the long descriptors to provide greater clarity and consistency In terminology. For example, the words mammary/mammaplasty have been replaced with the word breast for CPT® codes 19318, 19325, and 19328. Additionally, CPT® code 19361 has been made a parent code for the breast reconstruction procedure codes, but there Is otherwise no change to the description.

The musculoskeletal section of the book has only minimal changes for 2021. Specifically, the long descriptions for arthroscopic debridement of the shoulder (29822 and 29823) have been expanded to clarify what qualifies as limited versus extensive debridement services.

Two new codes were added and one code was deleted In the Respiratory section of the book. A new code has been created to report repair of nasal valve collapse with Implant (30468) and there Is also a new code for core needle biopsy of the lung or mediastinum (32408) which will replace CPT® code 32405, which Is being deleted as of December 31, 2020.

Changes to the Cardiovascular section of the book Include the addition of two new codes to report percutaneous ventricular assist device Insertion or removal from the right heart. In conjunction with these new codes, CPT® codes 33990-33992 will now describe the performance of percutaneous ventricular assist device Insertion of removal from the left heart. Transcatheter atrial septostomy procedures are being removed from the Medicine section (92992 and 92993) and added to the Cardiovascular section of the book (33741). Additionally, there are two new codes to report transcatheter Intracardiac shunt creation for congenital cardiac anomalies (33745 and 33746).

The only change to the Digestive section Involves the deletion of CPT® code 49220 which Is currently used to report staging laparotomy for Hodgkin’s lymphoma.

A single code is being added to the Male Genital section to report high Intensity-focused ultrasound ablation of the prostate (55880), which Is currently only reportable using HCPCS code C9747.

Two codes, 57112 and 58293, are being deleted from the Female Genital Section of the book, neither of which has a direct replacement within the 2021 code set. The deleted codes represented complex combination procedures and will presumably now be reported using one or more existing codes depending upon the services provided. The only other change to this section of the book Involves the addition of an add-on code to describe computer-aided mapping of the cervix during colposcopy (57465).

Four codes are being deleted from the Nervous System section of the book without direct replacement codes. The deleted codes Include CPT® code 61870, which is used to report Implantation of cortical neurostimulator electrodes requiring craniectomy; 62163, which describes retrieval of intracranial foreign body via neuroendoscopy; and 63180 and 63182, which represent laminectomy with sectioning of the dentate ligaments In the cervical region. CPT® codes 64455, 64479, 64480, 64483, and 64484 are now children of parent code 64400, but the descriptors are otherwise unchanged.

Two codes for dilation of eustachian tube using nasopharyngoscope (69705 and 69706) are being added to the Auditory System section of the book, while CPT® code 69605, which Is currently used to report revision mastoidectomy with apicectomy, Is being deleted.

Radiology

There are few changes to the Radiology section of the book for 2021, which should be a welcome relief after the extensive changes that occurred In 2020. The changes include a new code to describe low dose CT of the thorax to screen for lung cancer (71271), which Is currently reported using HCPCS code G0297, as well as a new code for evaluation of radiation exposure that exceeds institutional review threshold (76145).

Two codes are also being deleted from the Radiology section as of December 31, 2020, without specific replacement codes. The AMA Is deleting CPT® code 76970, which currently describes follow-up ultrasound without specification of site, as well as CPT® code 78135, which Is currently used to report differential organ and tissue kinetics during a red cell survival study, from the Nuclear Medicine subsection of the book.

In order to differentiate the screening CT scan of the thorax from the diagnostic CT scans of the same area, the word "diagnostic" Is being added to CPT® codes 71250, 71260, and 71270. The description of CPT® code 74425 Is also being revised to remove the specific exams pyelostogram, nephrostogram, and loopogram so that this CPT® code can be used for any antegrade urography service. To avoid confusion, "unilateral or bilateral" has been added to the description for anterior segment ophthalmic ultrasound (76513).

Pathology & Laboratory

There are 34 new codes, one deleted code, and eight codes with revised descriptors In the Pathology and Laboratory section of the 2021 book. Specifically, 10 new codes have been added to the Drug Assay subsection and 16 procedures have been moved from a Tier II pathology procedure to a Tier I pathology procedure. There are also two new codes to describe identification of infectious diseases using real-time amplification of RNA or DNA markers and three new codes for gene expression analysis or profiling performed on oncology specimens. Finally, two new codes have been added to the Chemistry subsection for quantitative analysis of alcohol and free estradiol levels.

CPT® code 81545, which currently describes gene expression analysis of fine needle aspirate obtained from the thyroid, will be deleted as of December 31, 2020. Although this code has no direct replacement, there are a number of PLA/CPT® codes that may be reported based upon the specific testing performed.

Medicine

There are also a relatively large number of changes to the Medicine section for 2021. First of all, there are three new codes to describe vestibular evoked myogenic potential (VEMP) testing (92517, 92518, and 92519) and four new codes to report auditory evoked potential testing (92650, 92651, 92652, and 92653). The existing codes, which describe limited auditory evoked potential testing (92586) and comprehensive auditory evoked potential testing (92585) are being deleted as a result.

The existing category III codes for external electrocardiographic recording for more than 48 hours up to 21 days (0295T, 0296T, 0297T, and 0298T) are being deleted In favor of eight new codes In the Medicine section. Of these eight new codes, four will be used to report recordings of more than 48 hours up to seven days(93241, 93242, 93243, and 93244), while the other four codes will be used to report recordings of more than seven days up to 15 days (93245, 93246, 93247, and 93248).

There are currently two codes to describe remote Imaging for detection or monitoring of retinal disease (92227 and 92228). These two codes have been modified and a third code has been added (92229). All three of these codes will be used for remote Imaging of the retina In the detection or monitoring of retinal disease. Selection of the appropriate code will depend upon the staff providing Interpretation and report; 92229 will be used for automated analysis and report, 92227 should be assigned when clinical staff review the results and provide a report, and 92228 will be assigned when a physician or other qualified health care professional reviews the results and produces a report.

Several codes have been deleted from the Pulmonary subsection, Including quantitative expired gas collection (94250), breathing response to CO2 (94400), pulmonary compliance study (94750), carbon dioxide determination by Infrared analyzer (94770), and bronchial challenge testing using antigens or gases (95071). One code was also added to the Pulmonary subsection; namely 94619, which describes exercise testing for bronchospasm Including spirometry and pulse oximetry.

Category III

There are 20 new Category III codes representing a wide variety of new and emerging services including endovascular venous arterialization with stent graft of the tibial or peroneal vein (0620T), trabeculostomy ab Interno using laser (0621T and 0622T), automated quantification and characterization of coronary plaque from CTA data (0623T, 0624T, 0625T, and 0626T), percutaneous Injection of allogeneic material Into the Intervertebral disc space of the lumbar region (0627T, 0628T, 0629T, and 0630T), visible light hyperspectral Imaging measurement of the extremity(Ies) (0631T), transcatheter ultrasound ablation of the pulmonary artery nerves (0632T), CT of the breast (0633T, 0634T, 0635T, 0636T, 0637T, and 0638T), and wireless thermal anisotropy measurement(s) with assessment of flow In CSF shunt (0639T).

Twenty-two (22) Category III codes are expiring; these include cryopreservation of ovarian tissue (0058T), breath test for heart transplant rejection (0085T), long-chain fatty acids In RBC membranes (0111T), common carotid IMT study for assessment of coronary artery risk factor (0126T), transforaminal epidural Injection using ultrasound guidance (0228T, 0229T, 0230T, and 0231T), external heart rate and 3-axis accelerometer data recording and report (0381T, 0382T, 0383T, 0384T, 0385T, and 0386T), Intraoperative use of kinetic balance sensor during knee replacement surgery (0396T), multi-spectral digital skin lesion analysis (0400T and 0401T) and oversight of the care of an extracorporeal liver assist system patient (0405T).

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