2022 CPT coding updates

99211 –
Revised code descriptor

Office or other outpatient visit for the evaluation and management (E/M) of an established patient, that may not require the presence of a physician or other qualified health care professional.

Editorial revision to remove the statement “presenting problems are usually minimal” from the code descriptor.

The statement was inadvertently left in the descriptor of code during the 2021 E/M code updates.

The editorial revision does not change the way CPT code 99211 is reported.

Foreign Body/
Implant - New
definition

An object intentionally placed by a physician or other qualified health care professional for any purpose (e.g., diagnostic or therapeutic) is considered an implant.

An object that is unintentionally placed (e.g., trauma or ingestion) is considered a foreign body.

If an implant (or part thereof) has moved from its original position or is structurally broken and no longer serves its intended purpose or presents a hazard to the patient, it qualifies as a foreign body for coding purposes, unless CPT coding instructions direct otherwise or a specific CPT code exists to describe the removal of that broken/moved implant.

New definition and introductory language were added to the Surgery Guidelines.

The definition clarifies the difference between an implant versus a foreign body.

It also specifies other conditions that qualify an implant as a foreign body for coding purposes.

Refer to specific guidance with instructions or specific CPT code(s) listing that describe the removal of the broken or displaced implant.

Repair (Closure) – Revised guidelines

(12001 – 12018)

Simple repair is used when the wound is superficial (e.g., involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures) and requires simple one-layer closure. Hemostasis and local or topical anesthesia, when performed, are not reported separately.

The Integumentary System, Repair (Closure) guidelines were revised. Prior to 2022, the Simple Repair guidelines stated that simple repair included local anesthesia and chemical or electrocauterization of wounds not closed. This statement was often misinterpreted to mean that simple repair codes were reportable when electrocauterization was used without placing sutures.

In order to address the issue, the guidelines have been revised to clarify that chemical cauterization, electrocauterization, or wound closure using adhesive strips as the sole repair material is included in the appropriate E/M code.

Additionally, the guidelines were revised to clarify that when hemostasis and local or topical anesthesia are performed for the simple repair, they are not reported separately.

Use the codes in this section (CPT codes 12001 – 12018) to designate wound closure utilizing sutures, staples, or tissue adhesives (e.g., 2-cyanoacrylate), either singularly or in combination with each other, or in combination with adhesive strips.

Chemical cauterization, electrocauterization, or wound closure utilizing adhesive strips as the sole repair material are included in the appropriate E/M code.

Pathology
Clinical
Consultations Guidelines –
Revised
guidelines,
new codes

(80503, 80504, 80505, 80506)

A pathology clinical consultation is a service, including a written report, rendered by the pathologist in response to a request (e.g., written request, electronic request, phone request, or face-to-face request) from a physician or other qualified health care professional that is related to clinical assessment, evaluation of pathology and laboratory findings, or other relevant clinical or diagnostic information that requires additional medical interpretive judgment.

Reporting pathology and laboratory findings or other relevant clinical or diagnostic information without medical interpretive judgment is not considered a pathology clinical consultation.

The pathology clinical consultation services (80503, 80504, 80505, 80506) may be reported when the following criteria have been met:

• The pathologist renders a pathology clinical consultation at the request of a physician or other qualified health care professional at the same or another institution.

• The pathology clinical consultation request is related to pathology and laboratory findings or other relevant clinical or diagnostic information (e.g., radiology findings or operative/procedural notes) that require additional medical interpretive judgment.

A pathologist may also render a pathology clinical consultation when mandated by federal or state regulation (e.g., Clinical Laboratory Improvement Amendments [CLIA]).

Selection of the appropriate level of pathology clinical consultation services may be based on either the total time for pathology clinical consultation services performed on the date of consultation or the level of medical decision making as defined for each service.

Consultant time includes the following activities, when performed:

• Review of available medical history, including presenting complaint, signs and symptoms, and personal and family history.
• Review of test results.
• Review of all relevant past and current laboratory, pathology, and clinical findings.
• Arriving at a tentative conclusion/differential diagnosis.
• Comparing against previous study reports, including radiographic reports, images as applicable, and results of other clinical testing.
• Ordering or recommending additional or follow-up testing.
• Referring and communicating with other health care professionals (not separately reported).
• Counseling and educating the clinician or other qualified health care professional.
• Documenting the clinical consultation report in the electronic or other health record.

Physician review of pathology and laboratory findings is frequently performed while providing care to patients. Review of pathology and laboratory test results occurs in conjunction with the provision of an E/M service.

Following the AMA/Specialty Society Relative Value Scale (RVS) Update Committee (RUC) recommended review, the following changes were implemented:

• New codes, guidelines, parentheticals added to provide further clarity for defining and reporting pathology clinical consultation services.
• The subsection heading for Pathology Clinical Consultations was revised.
• A table added that provides instructions on how to identify the level of MDM.
• CPT Codes 80500 and 80502 were deleted.
• Codes 80503, 80504, 80505, 80506 were established for reporting pathology clinical consultation for 
  • limited, 
  • moderately complex, 
  • highly complex, and 
  • prolonged pathology clinical consultation services.

Codes 80503-80504 include specific language that assist in code selection and reporting of these services. This guidance includes language that identifies choosing a level of service according to the type of MDM provided and a notation regarding the amount of time commonly spent for each level of service.

Pathology clinical consultation services codes (80503, 80504, 80505, 80506) describe physician pathology clinical consultation services provided at the request of another physician or other qualified health care professional at the same or another facility or institution.

Review of pathology and laboratory test results that occurs in conjunction with an E/M is considered part of the data element of the E/M service and is not separately reported.

Reporting pathology and laboratory findings or other relevant clinical or diagnostic information, without medical interpretive judgment is not considered a pathology clinical consultation.

Communication of pathology lab results is inherently included in the E/M.

Pathology clinical consultation must be reported based on the review and enumeration of the MDM elements or time when determining level of service.

Minimal time reporting requirements and restriction from use in conjunction with other consultation services that are already specifically identified within the pathology code section (88321-88325).

Reviewing pathology and laboratory results is not a separately reportable service, rather considered part of the non-face-to-face time activities associated with the overall E/M service.

Independent interpretation of results (not separately reported), may constitute an E/M service when results are communicated to the patient, family, or caregiver.