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ICD 10 CM Official Updates and Changes - 2024 Summary

There are 500+ code changes in 2024 including new, deleted, revised, and parent codes. These 2024 ICD-10-CM codes are to be used from the effective date of services from October 1, 2023, through September 30, 2024. 

New Codes  - 501 Additions
Deleted Codes - 25 Deletions
Revised Codes -  17 Revisions 
Converted to Parent Code - 25 Codes

Summary of the changes and updates

The updates include new codes, revised codes & deletions in 17 different chapters of ICD-10-CM. Changes to the Index and other revisions are also included in the updates. 

The distribution of codes and a summary of selected conditions are listed below,

Chapter 1: Infectious and parasitic diseases – 2 codes for Acinetobacter baumannii sepsis or the cause of diseases classified elsewhere.

Chapter 2: Neoplasms – 13 codes, including 10 codes for desmoid tumors. Desmoid tumors are a rare type of tumor arising in deep connective and soft tissues and often have a variable and unpredictable course. Desmoid tumors do not metastasize and are not classified as malignant. They tend to be locally aggressive, infiltrative, and destructive. They may also be known as aggressive fibromatosis. Desmoid tumors can occur in any soft or connective tissue throughout the body, but are usually categorized into four general areas: abdominal wall; extremities/shoulder and pelvic girdles/chest wall; intraabdominal/retroperitoneal/pelvic cavity; head and neck/intrathoracic.

Chapter 3: Diseases of blood and blood-forming organs and disorders involving immune mechanism – 8 codes, including codes for Sickle-cell conditions with dactylitis. Dactylitis is a severe inflammation of the fingers and toes commonly seen in infants with sickle cell anemia.

Chapter 4: Endocrine, nutritional, and metabolic diseases – 18 codes. Included are codes for insulin resistance and hypoparathyroidism.

Chapter 6: Diseases of nervous system – 24 codes. There are new codes for Lafora Body Disease, or Lafora progressive myoclonus epilepsy, which is a neurodegenerative condition caused by a glycogen metabolism disorder that results in the accumulation of abnormal glycogen aggregates called Lafora Bodies in the brain, heart, and liver. Four codes are new for chronic migraine with aura, and five codes for Parkinson’s disease with/without dyskinesia, with/without fluctuations. Parkinson’s disease (PD) is a progressive neurodegenerative disease that presents with motor symptoms such as bradykinesia with muscle rigidity, tremor, and/or postural instability, as well as non-motor symptoms such as anxiety/panic attacks, problems with executive function, and pain.

Chapter 7: Diseases of eye and adnexa – 34 codes, including new codes for sickle-cell retinopathy, muscle entrapment by site, and foreign body sensations.

Chapter 9: Diseases of circulatory system – 10 codes. Codes include codes related to tachycardia, angina, and microvascular dysfunction.

Chapter 10: Diseases of respiratory system – 7 codes. Codes include pneumonia due to Acinetobacter baumannii and lung allograft dysfunction.

Chapter 11: Diseases of digestive system – 17 codes. New codes include acute appendicitis with generalized peritonitis, small intestinal bacterial or fungal overgrowth, and short bowel syndrome.

Chapter 13: Diseases of musculoskeletal system – 36 codes specific to osteoporosis of pelvis with pathological fracture.

Chapter 14: Diseases of genitourinary system – 15 codes including recurrent and persistent immunoglobulin A nephropathy (IgAN), the most common form of glomerulonephropathy.

Chapter 15: Pregnancy, childbirth, and puerperium – 6 codes, including new codes for intrahepatic cholestasis of pregnancy (ICP), a pregnancy-specific disorder where bile acid transport in the liver is altered. This leads to a build-up of bile acid in both the maternal circulation as well as the fetal amniotic fluid.

Chapter 17: Congenital malformations – 22 codes, including specific types of craniosynostosis.

Chapter 18: Symptoms, signs, and abnormal clinical and laboratory findings – 18 codes, including codes for foreign body sensation and breast density.

Chapter 19: Injury, Poisoning – 12 codes for the toxic effect of gadolinium.

Chapter 20: External causes of morbidity – 123 codes for objects entering through a natural orifice. Examples are buttons, batteries, plastic objects, jewelry, etc.

Chapter 21: Factors influencing health status and contact with health services – 30 codes. These codes include a variety of conditions such as carrier status, history codes, and codes related to Social Determinants of Health (SDOH). The new subcategory “Caregiver’s noncompliance with patient’s medical treatment and regimen” is an example.

Telehealth Updates 2023

The CMS released new updates in January 2023 for the medicare fee schedule summary for telehealth services. 

The updates are effective from January 1, 2023 and the implemented date is January 3, 2023. 

The major changes are Medicare Physician Fee Schedule and mentioned following four category and every providers, coders and billing staff knows this guidelines and changes.

  • Telehealth originating site facility fee payment amount
  • Expansion of coverage for colorectal cancer screening
  • Coverage of Audiology services
  • Other covered services

The Medicare will continue to pay the telehealth service payment at same rate in person outpatient fee rate through out end of the 2023, And there is no changes and or decrease the fee rate. 

And also, the Medicare will continuously paying the audio visit service CPT code 99441, 99442 & 99443 at the same rate of outpatient established office rate for the length of service/time spends with the patient.

For Medicare patients, the provider would continue to bill the telehealth claims with the place of services indicate that the service bill under In-Person visit. And the claims must be billed with modifier 95 to indicate the service is performed in telehealth.

For Medicare adding new HCPCS codes to the list of telehealth services on a category 1, and the HCPCS codes are G0316, G0317, G0318, G3002, and G3003.

We are keeping many services that are temporarily available as telehealth services for the duration of  the COVID-19 Public Health Emergency (PHE) on a Category 3 basis through CY 2023 and including the following CPT codes.

The CPT codes are 90875, 90901, 92012, 92014, 92550, 92552, 92553, 92555-92557, 92563, 92567, 92568, 92570, 92587, 92588, 92601, 92625-92627, 94005, 95970, 95983, 95984, 96105, 96110, 96112, 96113, 96127, 96170, 96171, 97129, 97130, 97150-97158, 97530, 97537, 97542, 97763, 98960-98962, 99473, 0362T, and 0373T. 

These codes are available up to through December 31, 2023 in Medicare telehealth list.

The Category 3 CPT codes in telehealth services will be covered through 2023 and the Non-facility payment rates for telehealth services will remain the same through 2023 (physician offices are defined by Medicare as “Non-Facility” setting.

So this means telehealth payments will remain the same as in-person through 2023 and the direct supervision may continue to be provided virtually through 2023.

The CMS decided to continue paying for all of the codes on the telehealth list that were scheduled to stop 151 days after the PHE through the end of 2023.

Telehealth Originating site facility fee rate Update

The payment amount for HCPCS code Q3014 (Telehealth originating site facility fee) is 80% of the lesser of the actual charge, or $28.64 for CY 2023 services.

Other than office visit codes, the E/M visits includes following,

  • Hospital inpatient, 
  • Hospital observation, 
  • Emergency department, 
  • Nursing facility, 
  • Home services, 
  • Residence services, and 
  • Cognitive impairment assessment visits. \
For 2023, Medicare adopting the revised CPT codes for Other E/M visits (except for prolonged services)
  • G0316 for reporting prolonged hospital inpatient or observation services
  • G0317 for prolonged nursing facility services
  • G0318 for prolonged home or residence services
  • G2212, for  prolonged office/outpatient services
  • G3002 - Chronic Pain Management
  • G3003 - Chronic Pain Management 

Place of Service Updates

The place of services code is provided to pay the claims correctly at the same time the health care providers need for the specificity than Medicare for the services rendered. And the Medicare does not always need this greater the specificity to pay the claims.

The following two codes are created to meet the industry standards,

POS 02: Telehealth Provided Other than in Patient’s Home Descriptor

  • The location where health services and health related services are provided or received, through telecommunication technology. 
  • Patient is not located in their home when receiving health services or health related services through telecommunication technology. 

POS 10: Telehealth Provided in Patient’s Home Descriptor

  • The location where health services and health related services are provided or received through telecommunication technology. 
  • Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology

But the Medicare does not identified a need for new place of service code (POS 10). The MACs will instruct their providers to continue to use the Medicare billing instructions for Telehealth claims in specified under section Pub. 100-04.

Reference

Medicare Claims Processing Manual, Chapter 12, section 190. 

To see the list of telehealth codes added

Biofeedback Procedures Guidelines

CPT Code History & Guidelines

There are three CPT codes are available,

  • 90901 -  Biofeedback training by any modality
  • 90912 - Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; initial 15 minutes of one-on-one physician or other qualified health care professional contact with the patient
  • +90913 - Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; each additional 15 minutes of one-on-one physician or other qualified health care professional contact with the patient (List separately in addition to code for primary procedure)

The CPT 90911 was deleted in 2022 and the CPT 90912 & +90913 was added in Jan'2020. The purpose of this codes added,

The provider or other qualified healthcare professional will be trained the patients to control of involuntary bodily functions. There are,

  • Altering brain activity,
  • Blood pressure,
  • Heart rate, and
  • Other bodily functions that the patient cannot normally control voluntarily.

This service is done for conditions such as fecal or urinary incontinence. EMG and manometry, if performed, are included with this service.

  • The CPT 90912 can reported for the first 15 minutes of face–to–face service with the patients, and 
  • The CPT 90913 can be reported for each additional 15 minutes of face–to–face biofeedback training with the patient.

Clinical View

The physician uses the equipment that measures and responds to very slight changes in the body, such as changes in temperature, heart rate, blood pressure, and muscle tension, and provides feedback to the patient via lights, sounds, and meters.

And by using this equipment, and other therapeutic methods, the provider guides the patient through practices to alter his bodily functions and learn to control his reactions to help treat his disorders.

In this service, the provider is usually a urologist who first assesses and documents that reasons why the patient is a good candidate for biofeedback.

The provider then uses biofeedback–assisted pelvic muscle education (PME) which may include measurement of muscle contraction through an electromyography (EMG) and vaginal or rectal sensors and/or rectal manometry devices to help the patient become more aware of the pelvic muscles and assist in their movement.

The service may also include other techniques, such as relaxation, to help control involuntary bodily movements.

After completion of the test, the providers will take the printouts from the testing and his/her written interpretation of each of the tests in the patient’s medical record.

Limitation and Frequency

The Biofeedback sessions often have limits of four to six treatments over a four–week period. If it's exceeded as a result, payers will deny claims that exceed the frequency limit unless you can prove that the patient's specific condition requires additional services.

Payer Specific Updates

Some payers still consider biofeedback bladder training to be experimental and investigational services.

BCBS Updates

Covered ICD Codes

The listed below diagnosis are considered as the medical necessity

  • G44.201 Tension-type headache, unspecified, intractable
  • G44.209 Tension-type headache, unspecified, not intractable
  • G44.211 Episodic tension-type headache, intractable
  • G44.219 Episodic tension-type headache, not intractable
  • G44.221 Chronic tension-type headache, intractable
  • G44.229 Chronic tension-type headache, not intractable
  • G43.001 - Migraine without aura, not intractable, with status migrainosus
  • G43.009 - Migraine without aura, not intractable, without status migrainosus
  • G43.011 - Migraine without aura, intractable, with status migrainosus
  • G43.019 - Migraine without aura, intractable, without status migrainosus
  • G43.101 - Migraine with aura, not intractable, with status migrainosus
  • G43.109 - Migraine with aura, not intractable, without status migrainosus
  • G43.111 - Migraine with aura, intractable, with status migrainosus
  • G43.119 - Migraine with aura, intractable, without status migrainosus
  • G43.401 - Hemiplegic migraine, not intractable, with status migrainosus
  • G43.409 - Hemiplegic migraine, not intractable, without status migrainosus
  • G43.411 - Hemiplegic migraine, intractable, with status migrainosus
  • G43.419 - Hemiplegic migraine, intractable, without status migrainosus
  • G43.501 - Persistent migraine aura without cerebral infarction, not intractable, with status migrainosus
  • G43.509 - Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus
  • G43.511 - Persistent migraine aura without cerebral infarction, intractable, with status migrainosus
  • G43.519 - Persistent migraine aura without cerebral infarction, intractable, without status migrainosus
  • G43.601 - Persistent migraine aura with cerebral infarction, not intractable, with status migrainosus
  • G43.609 - Persistent migraine aura with cerebral infarction, not intractable, without status migrainosus
  • G43.611 - Persistent migraine aura with cerebral infarction, intractable, with status migrainosus
  • G43.619 - Persistent migraine aura with cerebral infarction, intractable, without status migrainosus
  • G43.701 - Chronic migraine without aura, not intractable, with status migrainosus
  • G43.709 - Chronic migraine without aura, not intractable, without status migrainosus
  • G43.711 - Chronic migraine without aura, intractable, with status migrainosus
  • G43.719 - Chronic migraine without aura, intractable, without status migrainosus
  • G43.801 - Other migraine, not intractable, with status migrainosus
  • G43.809 - Other migraine, not intractable, without status migrainosus
  • G43.811 - Other migraine, intractable, with status migrainosus
  • G43.819 - Other migraine, intractable, without status migrainosus
  • G43.821 - Menstrual migraine, not intractable, with status migrainosus
  • G43.829 - Menstrual migraine, not intractable, without status migrainosus
  • G43.831 - Menstrual migraine, intractable, with status migrainosus
  • G43.839 - Menstrual migraine, intractable, without status migrainosus
  • G43.901 - Migraine, unspecified, not intractable, with status migrainosus
  • G43.909 - Migraine, unspecified, not intractable, without status migrainosus
  • G43.911 - Migraine, unspecified, intractable, with status migrainosus
  • G43.919 - Migraine, unspecified, intractable, without status migrainosus
  • G89.3 Neoplasm related pain (acute) (chronic)
  • K59.00 - Constipation, unspecified
  • K59.01 - Slow transit constipation
  • K59.02 - Outlet dysfunction constipation
  • K59.03 - Drug induced constipation
  • K59.04 - Chronic idiopathic constipation
  • K59.09 - Other constipation
  • N39.3 Stress incontinence (female) (male)
  • N39.41 Urge incontinence
  • N39.46 Mixed incontinence
  • N39.490 Overflow incontinence
  • R15.0 - Incomplete defecation
  • R15.1 - Fecal smearing
  • R15.2 - Fecal urgency
  • R15.9 - Full incontinence of feces

Modifier

  • Some payers may require modifier GP, Services delivered under an outpatient physical therapy plan of care.

Experimental or investigational

Biofeedback is considered experimental or investigational for treatment of all other conditions, including but not limited to

  • Anxiety disorders
  • Asthma
  • Bell palsy
  • Chronic pain (including but not limited to low back pain)
  • Cluster headache
  • Depression
  • Functional urinary incontinence
  • Hypertension
  • Insomnia
  • Mechanical urinary incontinence
  • Movement disorders, such as motor function after stroke, injury, or lower-limb surgery
  • Multiple sclerosis
  • Orthostatic hypotension in patients with spinal cord injury
  • Pain management during labor
  • Post-traumatic stress disorder
  • Prevention of preterm birth
  • Psychosomatic conditions
  • Raynaud’s disease
  • Sleep bruxism
  • Tinnitus
  • Vaginismus
  • Vulvodynia

Source 

  • http://mcgs.bcbsfl.com/MCG?mcgId=01-90900-01&pv=false
  • AAPC

BCBS Updates to Billing CPT 99080 & 99499

The Centers for Medicare and Medicaid services are allowed to submit claims with 12 diagnoses in CMS 1500 form.

However, some of the practice management systems will limit the diagnoses to fewer than 12 diagnoses.

If any practice management system limits the number of diagnoses to fewer than 12 and the supplemental claims can be submitted with E&M Codes with $ 0.01 or $0.00 based on whether the system allows it.

Billing and Coding Guidelines

The simple question is, how to capture all the diagnosis and billed it out to Florida Blue Insurance?. 
 
Submit a second line item with CPT 99080 other than the first 12 diagnoses. Initially, the BCBS accepted only CPT 99080 for additional diagnoses but now, the BCBS insurance will allow to bill CPT 99499 as well for the additional diagnoses. 

The BCBS can accept a zero-dollar charge ($0.00), or a penny charge ($0.01) if your system does not allow zero-dollar charges. 
 
If the claim is electronic, use frequency code “0.” This code will deny as incidental to the procedure code submitted on the primary claim and no payment will be applied. 
 
Billing with a penny charge needs no reconciliation on the outstanding balance for providers.

Use at least one clinical diagnoses code from the original claim in first position and all other additional ICD 10 CM codes in position 2 to 12. 
 
The billed all the diagnoses must be documented in the medical record and they should be supported as per the CMS guidelines. 

The supplemental claims must be submitted within 180 days from the original E&M services. 
 
If you have a capitated payment arrangement, do not submit date-span claims for office services (Place of Service 11).

The CMS may requires documentation, diagnosis coding, and claims submissions to align to each individual date of service and face-to-face encounter for the review. 

Please do not submit a corrected claim Frequency Type 7 or Type 8. A corrected claim Type 7 tells Florida Blue the original claim was wrong, and a Type 8 claim will void or cancel the original claim.

Evaluation and management 2023 updates

Evaluation and Management 2021 Updates 

The E&M 2021 changes primarily focused on the documentation and coding guidelines for office and outpatient visits (commonly referred to as E&M codes 99202-99215). 

The main goals of these changes were to reduce administrative burden, simplify documentation, and recognize the value of cognitive work performed by healthcare professionals.

Key aspects of the E&M 2021 changes included

The Elimination of history and physical examination requirements as key components for code selection.

The E&M guidelines now allow providers to choose the level of service based on either Medical Decision Making (MDM) or Total time spent on the encounter. 

While the documentation of the history and physical examination is still important for patient care, it is not required to determine the appropriate code level but it should be documented in the medical records.

A Revised guidelines for code selection based on medical decision-making (MDM. The MDM now has a greater role in a code selection. 

The E&M guidelines provide clear definitions and examples of the components of MDM, such as.,

  1. Number and complexity of problems addressed,
  2. Data reviewed and analyzed, and
  3. Risk of complications or morbidity.

Guidelines for Time Based Code Selection

Expansion of time as a determining factor for code selection. The Providers can now select the code level based on total time spent on the patient encounter, including both face-to-face and non-face-to-face time.

This change benefits providers who spend a significant amount of time on activities like care coordination, reviewing records, and discussing cases with other healthcare professionals.

E&M Updates for 2023 

Initially the above said guidelines were introduced to use only for office and outpatient visits and now , effective from Jan 1st 2023, these guidelines will be applicable for across all the level of E&M code selection. 

 There are some new guidelines Introduced for the specific services,

  • Hospital Inpatient and Observation (99221 to 99223, 99231 to 99239)
  • Emergency Department Visits (99281 to 99285)
  • Consultations codes (99242-99245, 99252-99255)
  • Nursing Facility Services codes (99304-99310, 99315, 99316)
  • Home or Residence Services codes 99341, 99342, 99344, 99345, 99347-99350

Glimpses of 2023 Changes and Updates

  • Deletion of Hospital Observation Services E/M codes 99217-99220
  • Revision of Hospital Inpatient and Observation Care Services E/M codes 99221-99223, 99231-99239 and guidelines
  • Deletion of Consultations E/M codes 99241 and 99251
  • Revision of Consultations E/M codes 99242-99245, 99252-99255 and guidelines
  • Revision of Emergency Department Services E/M codes 99281-99285 and guidelines
  • Deletion of Nursing Facility Services E/M code 99318
  • Revision of Nursing Facility Services E/M codes 99304-99310, 99315, 99316 and guidelines
  • Deletion of Domiciliary, Rest Home (eg, Boarding Home), or Custodial Care Services E/M codes 99324-99238, 99334-99337, 99339, 99340
  • Deletion of Home or Residence Services E/M code 99343
  • Revision of Home or Residence Services E/M codes 99341, 99342, 99344, 99345, 99347-99350 and guidelines
  • Deletion of Prolonged Services E/M codes 99354-99357
  • Revision of guidelines for Prolonged Services E/M codes 99358, 99359, 99415, 99416
  • Revision of Prolonged Services E/M code 99417 and guidelines
  • Establishment of Prolonged Services E/M code 993X0 and guidelines

Summary of Hospital inpatient and observation Changes

The Observation Care Discharge Services CPT 99217 has been deleted. 

  • To report observation care discharge services, see 99238, 99239

Initial Observation Care New or Established Patient 99218, 99219, 99220 have been deleted. 

  • To report initial observation care, new or established patient, see 99221, 99222, 99223 

Subsequent Observation Care 99224, 99225, 99226 have been deleted. 

  • To report subsequent observation care, see 99231, 99232, 99233

Revised CPT Code Description

Admission Service (Initial hospital inpatient or observation)

99221 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making.

When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.

99222 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.

When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.

99223 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making.

When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.

Follow up Service (Subsequent hospital inpatient or observation)

99231 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically
appropriate history and/or examination and straightforward or low level of medical decision making.

When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.

99232 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.

When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.

99233 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making.

When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.

Discharge Service - Hospital inpatient or observation

99238 Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter.

99239 more than 30 minutes on the date of the encounter.

For hospital inpatient or observation care including the admission and discharge of the patient on the same date, see 99234, 99235, 99236

*** For 99211 and 99281, the face-to-face services may be performed by clinical staff

Golden Rule - Pulse Oximetry with Evaluation & Management

CPT Code Description: -

  • 94760 - Noninvasive ear or pulse oximetry for oxygen saturation; single determination
  • 94761 - Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (e.g., during exercise)
The provider and or other qualified healthcare professional takes the oxygen 
saturation using the a sensor on the ear or finger from the patients.

To perform this service, the doctor places a sensor, such as one in the form of a clip, on the patient’s earlobe or fingertip.

The sensor uses a light shining through the body part to measure the oxygen saturation, detecting the differences in the ways blood cells with and without oxygen reflect light.
 
The Oxygen saturation, is also called as O2 sat, and the percentage of hemoglobin carrying oxygen molecules.
 
Guidelines: -

The CPT Codes ranges from 94010 to 94799 include laboratory procedure(s) and interpretation of test results.

If a separate identifiable evaluation and management service is performed on the same day, the appropriate E/M service code can be billed separately. Like,
  • New or Established Patient Office or Other Outpatient Services (99202 to 99215),
  • Office or Other Outpatient Consultations (99242 to 99245),
  • Emergency Department Services (99281 to 99285),
  • Nursing Facility Services (99304 to 99316),
  • Home or Residence Services (99341 to 99350),
The mentioned above listed CPT codes may be reported with modifier 25 based on the NCCI edits guidelines in addition to the 94010-94799.

General Information: -

The pulse oximetry codes are not reportable with any other service performed on the same day.

There is no NCCI edits for this CPT codes, but as per the CMS guidelines, the Medicare Physician as categorized into the "T" status code, which means they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider.

Additional Information: -

Pulmonary function tests (94011-94013) are reported for measurements in infants and young children through 2 years of age.

Pulmonary function testing measurements are reported as actual values and as a percent of predicted values by age, gender, height, and race.

Telemedicine Modifier 93 Updates'2022

The modifier 93 (Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System).

Modifier 93 is a new audio-only telemedicine code that is effective on Jan. 1, 2022. Modifier 93 describes services that are provided via telephone or other real-time interactive audio-only telecommunications systems.

This modifier is appropriate only if the real-time interaction occurs between a physician/other qualified health care professional and a patient who is located at a distant site.

When using this modifier 93, the communication during the audio-only service must be of an amount or nature that meets the same key components and/or requirements of face-to-face interaction.

Addition of Appendix T


This appendix is a listing of CPT codes that may be used for reporting audio-only services when appended with Modifier 93. Procedures on this list involve electronic communication using interactive telecommunications equipment that includes, at a minimum, audio. The codes listed in Appendix T will be identified with an audio speaker symbol in the 2023 code set. The list of codes contained in the appendix, used with Modifier 93, is effective April 1, 2022.

The below summary of CPT codes that may be used for reporting audio only services when appended with Modifier 93.

The Procedures on this list involve electronic communication using interactive telecommunications equipment that includes, at a minimum, audio. The codes listed below are identified with the audio symbol.

90785 Interactive complexity (List separately in addition to the code for primary procedure)
90791 Psychiatric diagnostic evaluation
90792 Psychiatric diagnostic evaluation with medical services
90832 Psychotherapy, 30 minutes with patient
90833 Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure)
90834 Psychotherapy, 45 minutes with patient
90836 Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure)
90837 Psychotherapy, 60 minutes with patient
90838 Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure)
90839 Psychotherapy for crisis; first 60 minutes
90840 Psychotherapy for crisis; each additional 30 minutes (List separately in addition to code for primary service)
90845 Psychoanalysis
90846 Family psychotherapy (without the patient present), 50 minutes
90847 Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (eg, stuttering, cluttering)
92522 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria)
92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
96040 Medical genetics and genetic counseling services, each 30 minutes face to face with patient/family
96110 Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument
96116 Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face to face time with the patient and time interpreting test results and preparing the report; first hour
96160 Administration of patient focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument
96161 Administration of caregiver focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument
97802 Medical nutrition therapy; initial assessment and intervention, individual, face to face with the patient, each 15 minutes
97803 Medical nutrition therapy; reassessment and intervention, individual, face to face with the patient, each 15 minutes
97804 Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes
99354 Prolonged service(s) in the outpatient setting requiring direct patient contact beyond the time of the usual service; first hour (List separately in addition to code for outpatient Evaluation and Management or psychotherapy service, except with office or other outpatient services [99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215])
99355 Prolonged service(s) in the outpatient setting requiring direct patient contact beyond the time of the usual service; each additional 30 minutes (List separately in addition to code for prolonged service)
99356 Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient or observation Evaluation and Management service)
99357 Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; each additional 30 minutes (List separately in addition to code for prolonged service)
99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
99408 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes
99409 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes
99497 Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face to face with the patient, family member(s), and/or surrogate
99498 Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)

Documentation


The totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via face-to-face interaction.

ICD 10 CM Updates

New Rules for CPT Category III T Codes

Attach the Medical Records at initial Claim Submission Please note that when submitting your initial claim for any one of the CPT codes spec...