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Get the FAQs for CPT® Changes

Get the FAQs for CPT® Changes

AAPC’s senior VP of products answers frequently asked questions about new, revised, and deleted CPT® codes for 2022.

This month, I will answer questions asked during my Nov. 23, 2021, webinar 2022 CPT® Coding Updates. This webinar shed light on CPT® code updates, why codes were updated, how to apply the new codes, and what should be documented to support them.

Your Questions Answered

1. When CPT® codes are out of numerical sequence, how do I find them quickly?

For re-sequenced codes, go to where the code would normally be in numerical order. You will see a note in red that refers you to the code range where the re-sequenced code can be found.

2. As a nurse practitioner, how would I use the SA modifier for E/M codes?

This depends on payer guidance. For example, according to Blue Cross Blue Shield, a supervising physician should use the SA modifier when billing on behalf of a physician assistant, advanced practice nurse, or certified registered nurse first assistant for non-surgical services.

3. Is there a reference or source that links the Category III deleted codes to “see” codes?

When you go to a deleted code in the CPT® code book or Codify by AAPC, there will be a parenthetical note that refers you to the appropriate code.

4. Is there any regulation (outside of CPT® coding guidance) that requires PLA codes to be used, or can a provider choose to opt out of using PLA codes altogether?

The only entity that can bill the proprietary laboratory analyses (PLA) code is the lab or manufacturer that requested it. If there is a PLA code, in that case, the lab or manufacturer will have to use it. If the test is done by a provider that is not the requesting lab or manufacturer, they would use a Category I code.

5. What is the difference between a third dose and a booster for COVID-19 vaccination?

A COVID-19 vaccine booster may be given after a person has completed their initial one- or two-dose vaccine series. An additional (third) dose is only approved for people with moderately to severely compromised immune systems to improve their response to the initial vaccine series.

(Source: www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/booster-shots-and-third-doses-for-covid19-vaccines-what-you-need-to-know)

6. Do any of the remote management codes include diabetes management using CBGM remotely?

There are specific codes for capillary blood glucose monitoring (CBGM) that would be more appropriate. Codes 95249, 95250, and 95251 should be reviewed to determine if the procedure you are inquiring about is best described by these codes.

7. When using code 98980, can you enter 98980 x2, or do you have to enter the code twice?

Remote therapeutic monitoring treatment management services code 98980 can only be reported once every 30 days for the first 20 minutes of the service. If an additional 20 minutes is performed within the 30 days, you would report add-on code 98981.

8. Can you clarify or give a scenario for when Category II and III codes are used?

Category II codes are reported for performance measures. Category III codes are reported for new and emerging technologies.

9. What is the best website to reference for coding changes, new codes, and deleted codes?

The best resource for a comprehensive list of all CPT® changes is Appendix B in the CPT® code book.

10. My understanding is that POS 02 is not going away: It will be used along with POS 10 as a telehealth place of service. Is that correct?

Place of service (POS) codes indicate the location where the service was performed. Although commercial payers may implement the new POS 10 Telehealth provided in patient’s home (please review your payer policies), Medicare instructs us to continue using POS 02 for all telehealth services provided using interactive audio and video telecommunications. (MM12427)

11. What are the definitions for the symbols used in the slide deck (red dot, blue triangle, hash sign, plus sign, circle with slash through it)?

The symbols shown in my presentation are standard CPT® conventions. Refer to your code book for the key. Symbol definitions are also noted at the bottom of pages in various code sections.

12. Does Medicare accept codes 63052 and 63053?

Medicare included laminectomy codes 63052 and 63053 in the Physician Fee Schedule for 2022. The national Medicare fee for 63052 is $263.70 for both the facility and non-facility amount; for 63053, it is $197.26 for both facility and non-facility.

13. Where is the COVID-19 vaccine table in the CPT® code book?

Page 721 in the standard edition or Appendix Q (page 1,021) in the Professional Edition of the CPT® code book. See also www.ama-assn.org/find-covid-19-vaccine-codes for an up-to-date resource. As we all know, codes and guidelines for reporting COVID-19-related services change often.

The 2022 CPT® Coding Updates webinar is now available on demand! Check it out at www.aapc.com/medical-coding-education/webinars.

Rae Jimenez
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About Has 29 Posts

Raemarie Jimenez, CPC, CIC, CPB, CPMA, CPPM, CPC-I, CDEO, CANPC, CRHC, CCS, is senior vice president of products at AAPC and a member of the Salt Lake City, Utah, local chapter.

2 Responses to “Get the FAQs for CPT® Changes”

  1. Karen Miller says:

    Hi Raemarie, can you provide the regulatory guidance that states only the lab or mfr that requested a PLA code can bill for the PLA code? We perform tests utilizing several platforms that pertain to PLA codes (i.e., Cepheid Xpert Xpress COV-2/Flu/RSV – 0241U; Biofire Respiratory Panel 2.1 – 0202U) and we bill the PLA code pertaining to that test. Item #4 in your article above indicates that our hospital system cannot bill the PLA code for these tests since we are not the requesting lab/mfr for that test. Can you please confirm? Thank you.

  2. Renee Dustman says:

    Sorry for any miscommunication. What Rae said is that labs and manufacturers are the ones that request the PLA codes, so naturally they would use the codes they requested.