Reporting on Multiple Code Updates

This report includes a collection of topics. Compliance, CPT® Panel Meeting, and new CPT codes for respiratory syncytial virus (RSV) vaccine administration are included in this report.

On the Centers for Medicare and Medicaid Services (CMS) website, there is an education tool to assist with the billing for assorted services ranging from venipunctures to supplies. The tool is named “Medicare Provider Compliance Tips” and can be found at MLN 4824456.

The American Medical Association (AMA) CPT Editorial Panel met in San Diego, CA on Feb. 1 and 2 last week to discuss applications for new CPT codes. There were 31 topics on the agenda including code set maintenance, Category III sundown, terminology standardization, hearing device services, coronary therapeutic services and procedures, prostate biopsy services, and online digital evaluation and maintenance (E&M).

Code set maintenance involved the removal of lowly utilized CPT codes. Category III codes are established for a period then converted to a regular CPT code. A number of specific Category III codes were discussed with proposed CPT options. The panel discussed the inconsistent use of the phrase, “qualified non-physician health care professional” throughout CPT. The prostate biopsy services topic was a discussion for reporting prostate biopsies and the radiology procedures which may also be performed. A topic which may be of interest to physician office staff is online digital E/M visits. There is a proposal to create a new section with CPT codes to capture these services/visits. I listened to the coronary therapeutic services and procedures presentation. This update will include changes to explanations, definitions, and CPT codes.

The MLN Connects Newsletter for Feb. 1, 2024, stated that CMS retroactively added two new CPT codes for RSV vaccine administration to the Medicare Physician Fee Schedule effective Oct. 6, 2023. The CPT codes are the following:

• 96380 – administration, RSV vaccine, and counseling, same day;
• 96381 – administration, RSV vaccine, and counseling, different days.

It is important to review various sources of new codes including AMA’s CPT Editorial Panel and CMS Coordination and Maintenance Committee Meetings. These meetings provide information on the “spirit” of the code or what drives the creation or deletion of a code. By participating in these meetings, the attendee has additional time to prepare for the implementation of codes as well as understand how the code changes will affect their organization.

Resources:

MLN Connects Newsletter, February 1, 2024

AMA CPT Panel February Agenda, https://www.ama-assn.org/practice-management/cpt

MLN 4824456 – https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/medicare-provider-compliance-tips/medicare-provider-compliance-tips.html