The CPT coding changes for 2021 have been released. Understanding the new codes is crucial to obtaining the proper reimbursement for your services and ADVOCATE has analyzed the changes and provided the highlights below.
The major changes in CPT 2021 affecting radiology fall under revisions to the Evaluation & Management guidelines. There are minimal other changes impacting radiology practices, but all are outlined below. All CPT changes are effective with January 1, 2021 dates of service. Below are highlights of the changes that will most commonly affect radiology practices.
Evaluation & Management
As anticipated, there were significant revisions to the Evaluation and Management codes for office and other outpatient visits. These changes come as a result of historically cumbersome documentation and administrative complexities with the prior coding guidelines and CPT code descriptions. The revised codes and coding guidelines should reduce unnecessary documentation requirements and allow the reporting of these visits to be resource driven.
The revised codes are largely based on medical decision making and time. The history and exam portions of the visit are to be documented as “medically appropriate,” but are not involved in the calculation of code selection. Ultimately, the documented level of care must be appropriate for the patient’s documented history.
It is also important to note that CPT 99201, the lowest level new patient visit option, has been deleted for 2021. Any new patient visit would be reported with 99202-99205 and any established patient would be reported with 99211-99215 in the office or other outpatient setting.
Revised:
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
|
99203
|
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter
|
99204
|
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter
|
99205
|
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter
|
99211
|
Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal
|
99212
|
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter
|
99213
|
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter
|
99214
|
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter
|
99215
|
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter
|
New:
A new add-on code has been developed to report additional time spent that would be reported only with the level 5 visit codes (99205 & 99215). Please note this code would not be commonly reported for radiology groups.
99417 | Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each 15 minutes of total time |
DIAGNOSTIC IMAGING
CT Lung Cancer Screening
A new code was developed for lung cancer screening to replace G0297. The existing codes for CT of the thorax (71250-71270) have been revised as “diagnostic” and should not be used for lung cancer screening.
71271 | Computed tomography, thorax, low dose for lung cancer screening, without contrast material |
Breast CT
New Category III codes were introduced for CT of the breast, with designations for unilateral/bilateral as well as standard contrast options. Note that Category III are for new and emerging technology.
0633T
|
Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast material |
0634T
|
Computed tomography, breast, including 3D rendering, when performed, unilateral; with contrast material(s) |
0635T
|
Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast, followed by contrast material(s)
|
0636T
|
Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast material(s)
|
0637T
|
Computed tomography, breast, including 3D rendering, when performed, bilateral; with contrast material(s)
|
0638T
|
Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast, followed by contrast material(s)
|
INTERVENTIONAL
CT Lung Biopsy
A new code was developed for lung biopsy that bundles imaging guidance. Existing code 32405 has been deleted.
32408 | Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed |
Prostate Ablation
A new Category I code was created for prostate ablation with ultrasound guidance.
55880 | Ablation of malignant prostate tissue, transrectal, with high intensity-focused ultrasound (HIFU), including ultrasound guidance |
Spinal Procedures
New Category III codes were introduced for percutaneous injection into the lumbar intervertebral disc.
0627T
|
Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; first level
|
0628T
|
Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; each additional level (List separately in addition to code for primary procedure)
|
0629T
|
Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with CT guidance, lumbar; each additional level (List separately in addition to code for primary procedure)
|
0630T
|
Percutaneous transcatheter ultrasound ablation of nerves innervating the pulmonary arteries, including right heart catheterization, pulmonary artery angiography, and all imaging guidance
|
It should also be noted that Category III codes 0228T-0231T for ultrasound guided transforaminal epidural injection have been deleted in 2021.
Advocate will provide more detail on the new codes as it becomes available and will discuss these changes and practical application further in our CPT 2020 Update webinar in December.