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 year and in general, across the board the changes are
minimal. All of the CPT changes are effective with January 1, 2024 dates of service. Below are
highlights for the update.
Coronary FFR CT
A new Category I code replaces the Category III codes 0501T-0504T for coronary fractional flow reserve (FFR).
Note that CPT 75580 is classified as augmentative AI, which means that a physician or QHP is required to interpret and report the data.
As a reminder, the CPT Appendix S first appeared in the 2023 CPT manual and categorizes AI into three main hierarchies based on “the clinical procedure or service provided to the patient and the work performed by the machine on behalf of the physician or other qualified healthcare professional (QHP).”
These AI classifications are as follows:
- Assistive: The machine works to detect only clinically relevant data. A physician or other QHP must interpret the data and report the results.
- Augmentative: The machine performs the work and analyzes or quantifies the data “in a clinically meaningful way.” This category also requires a physician or QHP to interpret and report the data.
- Autonomous: The machine performs the work, then automatically analyzes the data, interprets the information, and produces clinically relevant conclusions independently without physician or QHP involvement.
Cardiac Intraoperative Ultrasound (IOUS)
Four new Category I codes are available to report intraoperative ultrasound during cardiothoracic procedures.
Quantitative MRI Analysis Brain-CATEGORY III
Category III codes are released on a biannual basis. Two new Category III codes for AI-related brain MRI quantification software were announced on June 30, 2023 and will take effect Jan. 1, 2024.
As a reminder, Category III codes are “intended to be used for data collection to substantiate widespread usage or to provide documentation for the Food and Drug Administration (FDA) approval process.” Utilization of Category III codes is essential for the creation of future Category I codes that may lead to reimbursement.
Transcervical RFA of Uterine Fibroids
A new Category I code replaces the Category III code 0404T for ultrasound guided transcervical uterine fibroid radiofrequency ablation.
Dorsal SI Joint Arthrodesis
A new Category I code replaces the Category III code 0775T for image guided arthrodesis of the SI joint.
EVALUATION & MANAGEMENT
Changes to the E&M subsection of CPT are building on the significant revisions that have been made over the last few years.
For 2024, CPT removes the time ranges from the code descriptors for codes 99202-99205 and 99212-99215 and replaces them with a single time that “must be met or exceeded”.
This change aligns the office/outpatient times with the format of other E/M codes.
Aside from the above listed nerve injections for pain management, there are no other significant CPT changes for anesthesia for 2024.
No significant CPT changes for surgical pathology for 2024.
Sources: American Medical Association (AMA), American College of Radiology (ACR)
Advocate will provide more detail on the new codes as it becomes available.