Major Takeaways from the CPT Code Changes for 2024

By Marsha S. Diamond, Director of Coding Solutions

Well, the CPT books have now been released and, if you have not already received your copy, they are on their way! Please keep in mind these changes are not effective until January 1, 2024, however, CPT allows us to “review time” to get acquainted with new codes, revised codes and deleted codes so we may update our billing systems and inform appropriate staff before the 01/01/24 effective date.

Here are some of the major takeaways for 2024 for CPT: 

Time for Office/Outpatient Visits

Office/Outpatient visit encounters (99202-99215) time descriptors have been updated to indicate a minimum time needed (verbiage is “must be met or exceeded”) as opposed to the range previously utilized for these codes. This puts the descriptors for these E & M codes in line with all the other E & M codes in which time was already described utilizing this descriptor.

Split shared services clarified

If based on time, the service is reported by the provider who spent the majority of the face-to-face time or non-face-to-face time performing the service.

If based on MDM components, the substantive part of the MDM requires that the provider or QHCP made or approved the management plan for the number and complexity of problems addressed and takes responsibility for that plan with its inherent risk of complications and/or morbidity or mortality of patient management. If so, the provider has performed 2 of the 3 MDM components and has met the substantive portion of the MDM. 

Further guidelines are available in the E/M Services Guidelines of CPT.

Multiple E & M Services on the Same Date

As we saw in 2023, CPT now allows for more than one E/M service per day per provider in select instances, and, has added to those guidelines:

• Hospital inpatient/observation care and nursing facility services are stated in CPT as “per day” therefore, when multiple visits occur in the same setting, only one E/M services is still reportable.

• When more than one E/M service is reported and time is used to select the code level, only the time spent providing each individual service may be counted towards that service.

• For time spent in the ED, and the same provider/group provides a subsequent E/M service, the total time for the ED service and subsequent service may be combined when the ED service is not reported.

• If time spent in the office/outpatient setting, and subsequently seen in the hospital setting, that time can again be combined when only one service is reported.

Further guidelines are available in the E/M Services Guidelines of CPT.

Vaccine Updates

New vaccine codes continue to be added, and old ones removed.  Some of these codes are listed in the new 2024 CPT edition with the symbol that indicates “FDA pending” and others may/will be released between now and 01/01/24 so keep tuned for changes to these codes as the new COVID vaccines are approved and released.

+++

Marsha S. Diamond is Director of Coding Solutions at Aidéo Technologies. Find her on LinkedIn here.