2021 CPT Code Updates Cover CPT Radiology, Evaluation & Management, Category III Codes, & More
The American Medical Association (AMA) announced 2021 CPT code set changes, with the organization stating 329 editorial changes, 206 new codes, 54 deletions, and 69 revisions (AMA, 2020). Many of the editorial changes are the result of the 2021 E/M office visit code revisions. However, you can find editorial changes, such as guideline or parenthetical note changes, throughout the CPT Radiology, Surgery, Pathology and Laboratory, Medicine, and Category III Codes.
For this reason, it is imperative that coders carefully review Appendix B the and the new guidelines and notes each year. Appendix B contains all code additions, deletions, and revisions found in the manual, but CPT contains other additions because of the online updates.
The AMA discusses this in the Introduction of CPT and on the back cover of CPT. There have been many updates to procedures related to COVID-19 that are not in the manual for 2021, although they will be part of 2022 (AMA, 2020). We have covered these COVID-19 CPT codes in detail with YES HIM blog articles.
CPT Evaluation and Management
AMA has implemented a complete revision in 2021 for the Office or Other Outpatient Services. The organization deleted code 99201, and one of two elements are used to assign codes 99202-99205 and 99212-99215.
While these visits require a medically appropriate history and/or examination, these elements are no longer the key elements. In 2021, key components to assign the level are medical decision making or time. The new guidelines are lengthy and contain many definitions related to medical decision making.
The AMA developed new prolonged office or other outpatient code 99417, which coders shall use with code 99205 or 99215 when time has exceeded the minimum time by 15 minutes. CMS believes that coders should use the maximum time, so code G2212 was implemented for Medicare, instead of code 99417.
For other E/M services, continue to use the 1995 or 1997 guidelines.
In the Integumentary System, the AMA deleted two codes and revised 17, mostly related to breast repair and/or reconstruction codes, with new guidelines and many parenthetical notes at the code level. In the Musculoskeletal Subsection, the authors made revisions to arthroscopy of the shoulder with debridement to define discrete structures.
Further, guidelines state that coders report removal of loose body(ies) or foreign body(ies) only when equal to or larger than the diameter of the arthroscopic cannula and are only removed through a larger cannula, or enlarged portal, or with separate incision.
In the Respiratory system, the AMA added a code for minimally invasive repair of nasal valve collapse. They also deleted a code to make way for a new code to bundle a core needle biopsy of the lung or mediastinum including imaging guidance.
The CPT updates added three new codes to the Cardiovascular System for septostomy and shunting procedures for congenital cardiac anomalies. Further, codes were revised, and new codes added to enable specificity of right or left side for heart assist devices.
AMA added one new code to the Male Genital Subsection to capture ablation of malignant prostate tissue using High Intensity-Focused Ultrasound (HIFU), previously reported with unlisted procedure code 55899. This organization also created an add-on code for the Female Genital Subsection to allow computer-assisted mapping of the cervix.
The AMA added two new codes to the Auditory System to report nasopharyngoscopy with dilation of the eustachian tube.
Minimal changes occurred in the Radiology Section, with two new codes, two deleted, and six revised. AMA revised three codes to include the word “diagnostic,” and they added a code for CT thorax, low dose for lung cancer screening. The other new code captures medical physics dose evaluation for radiation exposure.
CPT Pathology and Laboratory
There were over 100 new codes to this section, including the most in the PLA codes. The section also includes eight deletions and 12 revisions.
There are 10 new therapeutic drug assays, including over-the-counter medications such as salicylate and acetaminophen. Several molecular pathology Tier 2 codes became Tier 1, and there were 4 new Tier 1 codes.
The AMA added codes in chemistry, Immunology and microbiology. This section also added many new codes for COVID-19 testing, treatment, and vaccination as previously discussed. The AMA releases the PLA codes on a quarterly basis and account for the most additions in this Section.
The Medicine Section comprises of 18 new codes, 9 deletions, and four revisions. The Medicine Section revised retinal imaging codes, and created a new code for point-of-care automated analysis. Automated retinal imaging provides immediate reports and findings using software for diabetic retinopathy patients.
The AMA added new codes for vestibular evoked myogenic potential (VEMP) and auditory evoked potentials (AEP). The organization converted previous Category III codes (0295T-0298T) to codes 93241-93248 to differentiate external extended ECG monitoring into categories of more than 48 hours up to 7 days, and more than 7 days up to 15 days.
CPT Category III Codes
Category III codes are temporary tracking codes used for emerging technology and are generally valid for five years. After five years, if not converted to a Category I code, instructions are to use an Unlisted code.
While a Category III code is available, coders must use it, rather than using an Unlisted code. AMA releases these codes semi-annually. The organization added 45 new codes, deleted 23 codes, and made one revision.
Most of the new codes describe surgical procedures that involve new technology procedures. Of the many deleted codes, most the AMA archived with instructions to use unlisted codes. Some were converted to Category I codes. For example, code 0295T crosswalks to 93241 or 93245.
Teri Jorwic, MPH, RHIA, CCS, CCS-P, FAHIMA, co-authored this article with Ann Zeisset, RHIT, CCS, CCS-P.