2024 CPT coding updates

By Faith C. M. McNicholas, RHIT, CPC, CPCD, PCS, CDC, Manager, Lead Coding and Reimbursement Strategist, November 1, 2023

Academy coding staff address important coding topics each month in DermWorld Coding Consult. Read more Derm Coding Consult articles.

The American Medical Association (AMA) has released the Current Procedural Terminology (CPT®) coding updates that will go into effect on Jan. 1, 2024. The updates that may impact dermatology practices are discussed below.

Special dermatologic procedures

Codes 96920-96922 have been revised to better align with the intended use of these service codes exclusively for psoriasis. Specifically, the parent code has been revised to include the term, “excimer” to identify the type of ultraviolet laser used to perform the service. The revision has also been made to indicate how the skin surface area is being treated and offer guidance to better understand the physician’s work involved in performing the service and prevent improper coding. The code descriptor has been revised by the inclusion of the words ‘excimer’ and the removal of ‘inflammatory disease’ and will now read as follows:

• 96920  Excimer laser treatment for psoriasis; total area less than 250 sq cm

• 96921  250 sq cm to 500 sq cm

• 96922  over 500 sq cm

Evaluation and management (E/M) services

Guidelines for selecting the level of service based on time

The E/M for office or other outpatient codes (99202-99205 [new patient] and 99212-99215 [established patient]) have been revised by replacing the total time range associated with each code with a minimum time threshold that must be met or exceeded to report the level of service. To this effect, the guidelines for selecting a level of service and the code descriptors for the office and other outpatient E/M services based on time have been revised to reflect these changes.

You may recall in 2021, the total times for E/M codes 99202-99205 and 99212-99215 were redefined for all office or other outpatient services as total time spent on the date of the encounter. As a result, these codes were revised accordingly with a time range assigned to each code.

However, in the 2023 Medicare Physician Fee Schedule final rule, CMS removed the time ranges from codes 99202-99205 and 99212-99215 in their reporting rules. Instead, they applied the time requirement of other E/M codes (e.g., Hospital Inpatient and Observation codes 99221-99223, 99231-99233) with a specific number of minutes for the total time on the date of the encounter that must be met or exceeded, rather than a range of minutes.

The 2024 AMA CPT revisions provide consistency with CMS policy to reduce the administrative burden for dermatologists and non-physician clinicians (NPCs).

Furthermore, the AMA has added a new table titled Reporting “Prolonged Services” and revised the “Prolonged Service With or Without Direct Patient Contact on the Date of an Evaluation and Management Service” guidelines to reflect these changes.

Levels of E/M services

Risk of complications and/or morbidity or mortality of patient management

In its continued effort to provide clarification of E/M reporting in the E/M guidelines, some editorial changes have been made regarding the Levels of Medical Decision Making (MDM) including the revision of “Parenteral controlled substances” to “Decision regarding parenteral controlled substances” to ensure consistency with the other examples listed in the column for high risk of morbidity from additional diagnostic testing or treatment.

Number and complexity of problems addressed at the encounter

The number and complexity of problems addressed at the encounter guidelines have been revised editorially to clarify that the term “risk” relates to risk from the patient’s condition as it relates to the MDM element (i.e., number and complexity of problems addressed at the encounter).

Split or shared visits

A new section has been added to the classification of E/M services guidelines titled “Split or Shared Visits.” Discussion of split or shared visits was initially added to the E/M guidelines in the CPT 2021 code set. The guidelines addressed how to report the split or shared visit using time for code-level selection but did not address code-level selection using MDM.

In 2024, the split or shared E/M visits instructions have been expanded to clarify appropriate reporting of split or shared visits using time or MDM for code level selection. Additionally, these guideline revisions make the split or shared E/M visit reporting instructions consistent with the CMS’s policy to reduce the administrative burden for physicians and NPCs.

When time is used for code selection for an E/M service at which two professionals (i.e., dermatologists and NPCs) act as a team, the E/M service is reported by the professional who spent the majority of the time (i.e., the substantive portion of the time) performing the service. When MDM is used for code selection, the E/M service is reported by the professional who made or approved the patient’s management plan for the number and complexity of problems addressed at the encounter and takes responsibility for that plan with its inherent risk of complications and/or morbidity or mortality of patient management (i.e., the substantive part of the MDM).

Multiple E/M services on the same date

Another section that has been added to the classification of E/M services guidelines with a new heading is “Multiple Evaluation and Management Services on the Same Date.” The new guidelines provide definitions and reporting instructions when more than one E/M service is provided by the same dermatologist or NPC or another dermatologist or NPC of the exact same specialty and subspecialty who belong to the same practice to a patient in different settings or facilities on the same date.

It is important to note that the hospital inpatient or observation services codes and the nursing facility services codes are “per day” codes and may only be reported once per day, even if the dermatologist or NPC provides more than one of these services in the same setting. However, when multiple services are provided in different settings or facilities on the same date by the same dermatologist or NPC, each of the services may be reported.

The new guidelines provide reporting instructions for the following circumstances in which multiple E/M services are provided to a patient on the same date:

• Multiple services in the same setting or facility

• Multiple services in different settings or facilities

• Emergency department (ED) services and services in other settings

• Discharge and readmission to the same facility

• Discharge from one facility and admission to another facility

• Critical care services with other E/M services

• The transition between outpatient, home, or ED and hospital inpatient and observation care services or nursing facility services.

The addition of the multiple E/M services on the same date section is part of an effort to provide further clarification of E/M reporting in the E/M guidelines and to amplify E/M section-specific guidelines that provide instructions for reporting multiple E/M services provided by the same dermatologist or NPC to the same patient in different settings or facilities on the same date.

Surgical pathology (88300 – 88309; 88321 – 88332)

The Surgical Pathology introductory guidelines have been revised to include a clarifying statement indicating that services 88300 through 88309 include accession, examination, and reporting. They do not include the services designated in codes 88311 through 88388 and 88399, which are coded in addition when provided.

Further, the unlisted procedures and services now include a new introductory guideline in the Surgical Pathology subsection stating that surgical pathology procedures that are not specified in 88300-88388 may be reported using the unlisted surgical pathology procedure code 88399.

Digital pathology digitization procedures

Digital pathology refers to systems in which slides are scanned into a computer so that slides can be examined digitally, rather than directly visualized through a microscope. Digitization of glass microscope slides facilitates/enables remote examination by the dermato- or pathologist.

There are 30 new category III add-on codes (X138T-X168T) that have been established to report additional clinical staff work and service requirements associated with digitizing glass microscope slides for primary diagnosis. The guidelines in this section have also been revised to further define digital pathology and to outline the appropriate and correct reporting of these codes. Each code (X138T-X168T) is reported as a one-to-one unit of service for each primary pathology service code.

The Category III digital pathology digitization procedure guidelines have been revised to indicate that the images captured are “whole-slide.” Further clarification that static digital photographic and photomicrographic imaging or digital video streaming of any portion of a glass microscope slide on mobile smartphone and tablet devices does not constitute a digital pathology digitization procedure.

New parenthetical notes have been established following pathology consultation codes 88321-88332 to refer users to also code X151T – X154T when the digitization of glass microscope slides is performed.

Appendix S

Artificial Intelligence Taxonomy and its guidelines have been revised to include new examples recently included in the CPT code set that are assistive and augmentative services. The guidelines have been grammatically revised to clarify the intent of the Augmentative and Level III definitions.

Since Appendix S became part of the code set in 2023, the terminology has been applied by the CPT Editorial Panel and now includes examples that should replace the codes listed as assistive and augmentative. The new examples better illustrate the work performed by the machine on behalf of the dermatologist or NPCs.

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