The CPT coding changes have been released.  Understanding the new codes is crucial to obtaining the proper reimbursement for your services.

ADVOCATE has analyzed CPT changes for this upcoming year and, in general across-the-board, the changes are minimal.  All of the CPT changes are effective with January 1, 2023 dates of service.

Below are highlights for the update.

RADIOLOGY-DIAGNOSTIC

Extremity Ultrasound

The existing LIMITED code for extremity ultrasound has been revised to further define a “focal evaluation of” a nonvascular extremity structure.  Code 76882 is a limited ultrasound of the patient’s joint or another extremity structure

A new code 76883 has been added for extremity nerve ultrasound has been added.  This code should be used when the provider examines the entire length of the nerve.

76882	Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft-tissue structure[s], or soft-tissue mass[es]), real-time with image documentation
76883	Ultrasound, nerve(s) and accompanying structures throughout their entire anatomic course in one extremity, comprehensive, including real-time cine imaging with image documentation, per extremity

 

INTERVENTIONAL RADIOLOGY

Percutaneous AV Fistula Creation

Two new codes are available for percutaneous or endovascular approaches for creating arteriovenous anastomoses. There are currently only codes to describe open surgical arteriovenous anastomosis creation.

The new codes include all vascular access, angiography, imaging guidance, and blood flow redirection or maturation techniques (eg, transluminal balloon angioplasty, coil embolization) performed for fistula creation

36836	Percutaneous arteriovenous fistula creation, upper extremity, single access of both the peripheral artery and peripheral vein, including fistula maturation procedures (eg, transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation
36837	Percutaneous arteriovenous fistula creation, upper extremity, separate access sites of the peripheral artery and peripheral vein, including fistula maturation procedures (eg, transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation

 

Nerve Injections

Existing somatic nerve injection codes have been revised to include imaging guidance when performed.

64415	Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, including imaging guidance, when performed
64416	Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, continuous infusion by catheter (including catheter placement) including imaging guidance, when performed
64417	Injection(s), anesthetic agent(s) and/or steroid; axillary nerve, including imaging guidance, when performed
64445	Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, including imaging guidance, when performed
64446	Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, continuous infusion by catheter (including catheter placement) including imaging guidance, when performed
64447	Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, including imaging guidance, when performed
64448	Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, continuous infusion by catheter (including catheter placement) including imaging guidance, when performed

 

EVALUATION & MANAGEMENT

Changes to the E&M subsection of CPT are building on the revisions that were made to office/outpatient E&M in 2021.   Once again, these changes shift code selection to be based on medical decision making and time spent with the patient and are intended to reduce burden of documentation for the provider.

The changes for 2023 will affect hospital inpatients, observation care, consultations*, emergency room visits, nursing facility services, and home, rest home and domiciliary E&M codes.  Highlights of the changes include:

• Level of E/M services will be based on the following:
  • The level of the MDM as defined for each service OR
  • The total time for the E/M service performed on the date of the encounter.
• History and exam no longer used to select the level of code
• Revision/combining of Hospital Inpatient and Observation Care Services
• Hospital Observation Services E/M codes were deleted
• A new code has also been added for prolonged services for to accompany the existing code 99417 which is prolonged services in the office/outpatient setting. Keep in mind that payers may have different rules regarding coding and counting time for prolonged services.

*Reminder that not all payers accept the consultation codes, and therefore office/outpatient and inpatient visit codes may be utilized depending on the payer.

 ANESTHESIA

Aside from the above listed nerve injections for pain management, there are no other significant CPT changes for anesthesia for 2023.

PATHOLOGY

No significant CPT changes for surgical pathology for 2023.

 

Advocate will provide more detail on the new codes as it becomes available.

Jennifer Bash, RHIA, CIRCC, RCCIR, CPC, RCC

Director of Coding Education