Take 5: Get Caught Up on Coding and Billing News
New COVID-19 vaccine status codes, changes and corrections to the 2022 CPT code set, Medicare Physician Fee Schedule (MPFS) payment changes, and prior authorization code list changes — that’s what’s on the agenda this month. Read all about it!
3 New Codes Improve COVID-19 Vaccination Status
An April 1, 2022, update to the 2022 ICD-10-CM code set has been released and should be used from April 1, 2022, through Sept. 30, 2022. This subsequent release replaces the Oct. 1, 2021, update of the ICD-10-CM code set for Fiscal Year 2022.
Of note, there are three new codes and one deleted code:
Delete Z28.3 Underimmunization status
Add Z28.310 Unvaccinated for COVID-19
Add Z28.311 Partially vaccinated for COVID-19
Add Z28.39 Other underimmunization status
This change allows clinicians to report a patient’s COVID-19 vaccination status more accurately.
The updated files are available for download at https://www.cdc.gov/nchs/icd/icd10cm.htm.
AMA Releases CPT® 2022 Code Changes
On Dec. 30, the American Medical Association (AMA) issued an errata and technical corrections for the current CPT® code set used to report physicians’ services.
Most of the changes are grammatical, but there are a few changes to code descriptors and parenthetical notes, particularly to the arthrodesis and laminotomy/laminectomy codes.
The effective date for these changes is Jan. 1, 2022.
Download the PDF from the AMA’s website for a record of all the changes and corrections that don’t appear in your 2022 CPT® code book.
Prior Authorization Code List Update
Effective Jan. 7, 2022, CPT® code 67911 Correction of lid retraction is removed from the prior authorization code list. The reason for the removal is because “this service is not likely to be cosmetic in nature and commonly occurs secondary to another condition,” the Centers for Medicare & Medicaid Services (CMS) states on its website.
Through the Calendar Year 2020 Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule (CMS-1717-FC (PDF)), CMS established a nationwide prior authorization process and requirements for certain hospital outpatient department (OPD) services.
The following hospital OPD services require prior authorization when provided on or after July 1, 2020:
- Blepharoptosis repair and brow ptosis repair are added
- Botulinum toxin injections
- Vein ablation
The following hospital OPD services require prior authorization when provided on or after July 1, 2021:
- Implanted spinal neurostimulators
- Cervical fusion with disc removal
CMS also revised the exemption process for hospital OPD providers and extended the exemption cycle. See CMS’ operational guide for complete details.
Congressional Act Delays Medicare Payment Adjustment
On December 10, the Protecting Medicare and American Farmers From Sequester Cuts Act (S.610) made several adjustments to Medicare sequestration reductions.
For starters, the Act extended the 2 percent Medicare sequester moratorium through March 31. Between April 1 and June 30, a downward 1 percent payment adjustment will be in effect for Original Medicare. And on July 1, the full 2 percent reduction will be reinstated, barring further Congressional action. The Act also adjusted the MPFS conversion factor by 3 percent. According to Healthcare Administrative Partners, the estimated conversion factor for 2022 will be $34.6062, instead of $33.5983.
The Act also delayed the Clinical Laboratory Fee Schedule private payer reporting requirement under Section 1834A of the Social Security Act:
- The next data reporting period is now Jan. 1, 2023 – March 31, 2023.
- Reporting will be based on the original data collection period, Jan. 1, 2019 – June 30, 2019.
The Act also extended the statutory phase-in of payment reductions resulting from private payer rate implementation:
- No payment reductions for CYs 2021 and 2022.
- Payment won’t be reduced by more than 15 percent for CYs 2023 through 2025.
Visit the PAMA Regulations webpage for more information on what data you need to collect and how to report it.
The Act also delayed implementation of the Medicare Radiation Oncology Model until 2023 and a 4 percent pay cut to Medicare and other federal programs resulting from Pay-As-You-Go Act requirements until CY 2023.