Neurology & Pain Management Coding Alert

Here’s why the AMA deleted a key phrase from the office/outpatient E/M code.

The AMA has released its list of new, revised, and deleted codes for CPT^® 2022. The new codes will be implemented on Jan. 1, 2022, so you’ve only got a couple of months to get up to speed.

The lowdown: While the new list is light on new codes for neurology and pain management coders, there are several key revisions — especially to evaluation and management (E/M) codes — that you’re going to want to note.

Read on for the info you’ll need for accurate CPT^® coding when 2022 rolls around.

AMA Updates 99211 to Match Other Office E/Ms

The main revision features the level one office/outpatient E/M code for established patients. In 2022, the descriptor will read 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional)

2021 descriptor: (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.)

The difference: The phrase “Usually, the presenting problem(s) are minimal.” has been deleted. “The reason for the deletion is an editorial revision to bring the descriptor for 99211 more into line with the rest of the office/outpatient evaluation and management (E/M) codes. The descriptors for those codes prior to 2021 all included a sentence that read, ‘Usually, the presenting problem(s) are....’ Now, they don’t,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

With the phrase removal, 99211’s descriptor is no more synched with the other office/ outpatient E/Ms: 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.).

“This change also removes a potential source of confusion,” says Cindy Hughes, CPC, CFPC, consulting editor of Cindy Hughes Consulting in El Dorado, Kansas. “For instance, 99211 may be reported when a nurse provides education to a newly diagnosed diabetic, but diabetes is by no means a minimal problem.”

In other words, even with the change, “99211 still represents an E/M (really an assessment and management) service provided by clinical staff as opposed to a physician or other qualified healthcare professional who may report higher levels of E/M services. Services described by 99211 must be medically necessary (i.e., clinically indicated) and be part of a plan of care by a physician or other qualified healthcare professional. This is why 99211 is not reportable for measuring a patient’s blood pressure at their request rather than per an established plan of care,” Hughes elaborates.

CCM Sees Revisions to Several Codes

Some less drastic — but still important — changes will also be made to several chronic care management (CCM) codes in 2022. Here’s a rundown of the 2022 versions of each code, along with the 2021 descriptors and some analysis as to how the codes will be different:

99490 (Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised, or monitored; first 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.)

2021 descriptor: (Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised, or monitored; first 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.)

The difference: CPT^® added “that” between “conditions” and “place.” This is a superficial edit designed to give the descriptor more clarity.

99491 (Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised, or monitored; first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.)

2021 descriptor: (Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored.)

The difference: CPT^® deleted “first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.”

Also, “that” was added between “conditions” and “place.”