COVID Code Consolidation, Spanish-Language Options, RSV Highlight Looming Code Changes

This past Friday, the American Medical Association (AMA) announced the much-anticipated release of the 2024 CPT® code set; however, there’s a bit of a catch. 

The code set is only available on the AMA’s Intelligent Platform to those in the healthcare industry that are licensed to use the CPT standard data file.

The big reveal of the 230 additions, 49 deletions, and 70 revisions will take place during the virtual AMA CPT Symposium over the course of three days, from Nov. 15-17.  

For those of us who have pre-ordered our CPT books, now we must wait patiently for them to ship, which typically occurs by the end of October or first week of November.

The AMA shared a few of the changes in a press release.

For those who speak Spanish, the AMA has included Spanish descriptors for its 11,163 procedures and services in order to bridge the language gap that currently exists, and to make healthcare more inclusive to those who speak Spanish.

One of the major changes for 2024 is the consolidation of more than 50 codes used to report COVID-19 vaccines, along with the approval of provisional codes 91318-91322 used for the reporting of the monovalent vaccine products from Moderna and Pfizer. Once the monovalent vaccines are approved by the U.S. Food and Drug Administration (FDA), these provisional codes will be effective.

Another notable addition is code 90480, which will be used to report COVID-19 vaccine administration, which replaces all previously approved product-specific vaccine administration codes (which will in turn negate some of the troublesome reporting errors).                                                                                                                                                                            Also, we will have five new CPT codes for reporting Respiratory Syncytial Virus, commonly known as RSV, which, per the AMA, will lead to “better tracking, reporting, and analysis that supports data-driven planning and allocation.”

Next, the AMA provides a glimpse into the evaluation and management (E&M) revisions, which are clarifications that were sought out by Centers for Medicare & Medicaid Services (CMS). 

First, the CPT editorial panel removed the time ranges from the office and other outpatient codes 99202-99215 in order to align with the format with the rest of the E&M codes.

Next, per the AMA, we will have a definition to determine the “substantive portion” of a split and/or shared E&M service between a physician and non-physician practitioner. It will be interesting to see if the definition has any impact when CMS releases the Medicare Physician Fee Schedule proposed rule for 2025.

Lastly, CPT will provide clearer instructions for codes 99234-99236, which are used when reporting hospital inpatient or observation care with admission and discharge services, when the patient stay spans two calendar dates. 

The AMA keeps the remaining changes close to their vest. Now, we sit and patiently wait for November.

About the Author:

Angela Jordan serves as executive vice president for Calm Waters AI. She oversees the development and implementation of ChartPal, a service that provides physicians and non-physician practitioners with coding and documentation reviews to inform customized education to improve documentation accuracy and compliance. 

Jordan brings three decades of medical coding, documentation, and compliance experience to her position. She has been a national member of the AAPC since 2000 and a member of AAPC’s National Advisory Board. She is a frequent presenter and lecturer on coding and compliance topics at national conferences and symposiums.  

Immediately prior to joining Calm Waters AI, Jordan served as senior manager, Advisory Solutions for Dallas-based Ventra Health, where she provided coding and compliance education and audit and litigation support for the organization’s clients. She holds credentials as a Certified Professional Coder (CPC), a Certified Professional Medical Scribe (CPMS) and Certified Obstetrics Gynecology Coder (COBGC).