The American Medical Association (AMA) has released 405 editorial changes in the 2022 CPT code set, including almost 250 new codes. The organization announced the updated CPT coding set in September, enabling organizations to begin planning for the year ahead.
Advances in medicine bring expanded coding, billing, reporting needs. Let’s take a look at a few coding highlights and challenges for 2022.
Opportunities in sight
COVID-19 vaccine codes
With the introduction of several vaccine formulations and manufacturers in 2021 – and now the addition of third doses – coding for these has become more complex.
Pfizer, Moderna, BioNTech, and Johnson & Johnson vaccines have been authorized by the FDA. The 2022 code set includes a series of 15 vaccine-specific codes to be used and a vaccine code finder resource. The purpose of the additional specificity with these codes is not just for billing; this is also a way to effectively track vaccination patterns by vaccine type and dose series across the U.S., as it’s crucial for analytics and research.
Digital medicine
Digital medicine services that fall under the telehealth umbrella have been expanding quickly, particularly during the pandemic. A new appendix included in the 2022 CPT code book provides a taxonomy for digital medicine services that supports additional awareness and deeper understanding of this approach to patient care.
Five new CPT codes have been developed for therapeutic remote monitoring. Remote patient monitoring codes that were introduced in 2020 will also remain in effect, maintaining high specificity to reporting.
Category 3 telehealth services were developed during the pandemic. These were slated to end at the end of 2021, but the Centers for Medicare and Medicaid Services (CMS) has proposed to pay for those until the end of 2023. That’s something providers will surely hear as good news, and more than 60 healthcare groups said so in a letter to CMS:
“Given the addition of a record number of eligible beneficiaries, telehealth may be the only way beneficiaries can gain access, especially those in rural or underserved communities.”
Chronic care management
Chronic care management (CCM) services have been around for a while, with 5 codes specified for reporting. These services are non-face-to-face services who have multiple (2 or more) chronic conditions. These 5 codes cover non-complex and complex CCM, designated by specific criteria and the complexity of medical decision making involved.
With the 2022 CPT code set, there are now 4 new codes for principal care management, which allow billing for patients with just 1 chronic condition. This is a major opportunity for telehealth providers to add additional patients into their CCM programs.
Challenges ahead
Time-based E/M coding
While time-based coding is not new, it seems like each year there are provisions that make it more complex. 2021 saw the introduction of a new system of time-based coding, differentiating between face-to-face and non-face-to-face time.
The biggest challenge of time-based coding that will continue into 2022 is the requirement for thorough supporting documentation. Providers must include multiple entries for multiple encounters even if on the same day – multiple care management phone calls or messages, with time spent on each, as examples.
Split and shared services
CMS currently allows non-physician practitioners to share services with physicians in inpatient, outpatient, observation, and ED settings. They are not allowed to share in nursing facilities.
For the proposed 2022 changes, in order to use shared services, the physician and non-physician practitioner must use time to select a code, not medical decision making (complexity). They must also bill the service under the clinician who has performed the substantive portion of the service, which is defined as more than 50%.
This may present a revenue challenge to organizations who use different secondary providers such as nurse practitioners and physician assistants.
Critical care services
There are several changes to critical care services such as allowing split critical care services, disallowing double billing by 2 physicians meeting jointly with a patient, and disallowing post-op critical care billing for surgeons if it is unrelated to the operative site.
These rules are increasingly complex, and provisions are crucial to educate affected providers and clarify how they will affect future operations and documentation practices. The critical care codes are overall more all-encompassing, with fewer add-ons available for multiple services and providers.
Looking ahead at your organization’s needs
Each new coding update presents a variety of learning opportunities, documentation requirements, and more questions. With an expert staffing partner, you can ensure your organization has tenured professionals on board to:
- help prepare for changes ahead of time
- shorten the learning curve
- set in place processes to maximize revenue and reduce denials
- avoid organizational frustrations
Launch your partnership with Team Harmony and expert coding professionals today:
