Are You Prepared for 2022 CPT® Code Changes?
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Every year, the American Medical Association® makes changes to the Current Procedural Terminology (CPT®) code set. Fortunately, 2022 CPT® code changes (effective on January 1, 2022) are minimal, with a few new codes and modifications to existing codes and descriptors.
Below we’ll review the various types of CPT® codes and the new and revised codes that pertain to optometry and ophthalmology procedures, so you are better prepared for billing medical insurance payers.
How Many CPT® Code Changes Are There for 2022?
There are 405 editorial changes in the CPT® code set for 2022. Changes consist of 249 new codes, 63 deletions, and 93 revisions. More than 40 percent of the code changes are connected to new technology services in Category III CPT codes and the expansion of the Proprietary Laboratory Analyses (PLA) codes. In addition, code changes apply to the reporting, tracking, and administration of the COVID-19 vaccine.
What is a CPT® Code?
CPT® codes were developed in 1966 by The American Medical Association to describe a medical, surgical, or diagnostic procedure that doctors and healthcare providers perform. CPT® codes ensure uniformity and are required for billing medical insurance payers.
CPT® codes are published by the AMA and consist of various categories/types of five-digit codes and two-character modifiers to describe any changes to the procedure. The codes can be numeric or alphanumeric, and some codes may have a fifth alpha character, such as F, T, or U.
What is a CPT® Modifier?
Modifiers are added to the Healthcare Common Procedure Coding System (HCPCS) or CPT® codes to provide additional information necessary for processing a claim. For instance, modifiers identify why a doctor or other qualified healthcare professional provided a specific service and procedure. Modifiers are placed at the end of the CPT® code with a hyphen.
Related Blog: Medical Billing Tips: How (and How Not) to Use Common Modifiers
What are the Types of CPT® Codes?
Category I Codes: Describes services, procedures, devices, and drugs (including vaccines) that are usually placed into sub-categories.
Category II Codes: Alphanumeric supplemental codes track follow-up care and outcomes for performance measurement, such as does the patient smoke. These codes are not linked to reimbursement.
Category III Codes: These are temporary alphanumeric codes when a physician uses a new or emerging technology, procedure, and services. Category III codes were “created for data collection, assessment, and payment of new services and procedures that currently don’t meet the criteria for a Category I code,” reports the AMA.
Proprietary Laboratory Analyses (PLA) Codes: PLA codes are an alphanumeric CPT® code set that the AMA CPT® Editorial Panel recently added to describe proprietary clinical laboratory analyses. PLA codes include a corresponding descriptor to identify tests for specific labs or manufacturers.
What New CPT® Codes Were Added for 2022?
Therapeutic Remote Monitoring
There are five new CPT codes to report therapeutic remote monitoring: 98975, 98976, 98977, 98980, and 98981. These new CPT codes “expand on remote physiologic monitoring codes that were created in 2020 (99453, 99454, 99457, and 99458),” reports the AMA.
Taxonomy
A new code set for taxonomy (Appendix R – Digital Medicine – Services Taxonomy) supports multifaceted digital medicine services in the following categories:
Clinician-to-patient services
Clinician-to-clinician services (consultation)
Patient-monitoring services
Digital-diagnostic services
PRO TIP: Ensure that synchronous services include interactive two-way real-time interactions of both parties simultaneously (audio/video required). Asynchronous services do not require live interactions and are store-and-forward transmissions, such as communicating via telephone, patient portal, or secure emails.
Principal Care Management
The CPT Editorial Panel created four new codes (99424, 99425, 99426, and 99427) to allow qualified healthcare providers to report care management services for patients with a single chronic condition. Previously, these services were reimbursed for patients with multiple chronic conditions. These new codes “better align with Medicare guidelines,” reports the AMA.
Drug-eluting Implant Procedure
Code 68841 is new and was added to describe a drug-eluting implant procedure involving the eye. The descriptor for 68841 is “Insertion of drug-eluting implant, including punctual dilation when performed, into lacrimal canaliculus, each.” Code 68411 will replace Category III code 0356T, and the AMA will delete code 0356T on January 1, 2022.
PRO TIP: Use code 68841 when a corticosteroid insert is placed into the canaliculus to deliver dexamethasone (brand name Dextenza) to treat pain and inflammation following eye surgery.
What CPT® Codes Were Revised for 2022?
Code 99211
The following descriptor was removed from 99211: “Usually, the presenting problem(s) are minimal.” The revised descriptor for 99211 is “Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional.”
PRO TIP: In 2021, Evaluation and Management (E/M) code 99201 was deleted due to low utilization. For more information about 2021 E/M codes, refer to our blog Managing 2021 Evaluation and Management Code Changes.
Code 92065
CPT Code 92065 refers to orthoptic training (vision therapy) administered in the office under the direction of a physician. Always verify benefit plan descriptions as some insurance plans exclude benefits for vision therapy. At the time of writing this blog, we were unable to determine what revisions were made to the code.
Codes 67141 and 67145
These two retinal detachment codes were revised in the prophylaxis subsection. The codes were edited to remove the reference to “1 or more sessions” so that the services may be valued as a 10-day procedure versus the current 90-day global, according to the 2022 Medicare Physician Fee Schedule Proposed Rule published July 23, 2021.
67141: “1 or more sessions” was removed from the descriptor. The new descriptor is “Prophylaxis or retinal detachment (e.g., retinal break, lattice degeneration) without drainage, cryotherapy, diathermy.”
67145: “1 or more sessions” and “(laser or xenon arc)” were removed from the descriptor. The new descriptor is “Prophylaxis of retinal detachment (e.g., retinal break, lattice degeneration) without drainage; photocoagulation.”
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