New Category I codes for percutaneous arteriovenous fistula creation and neuromuscular ultrasound have been created and will be available in the Current Procedural Termi¬nology (CPT®) 2023 code set. In addition to these codes, early-release Category III codes will be available on July 1, 2022 to report new technology such as, quantitative CT tissue characterization and quantitative magnetic resonance cholangiopancreatography (MRCP). This article provides an overview of the anticipated changes in 2023.
Revisions will also be made within several subsections of the evaluation and management (E/M) section to standardize the rest of the E/M sections of the CPT code set to follow the CPT Editorial Panel’s (the Panel’s) revisions to the office or other outpatient E/M codes (99202-99215) for the CPT 2021 code set.
Additionally, a new artificial intelligence (AI) taxonomy appendix will be added to clarify terms that best describe AI services, how these services are used, and how they can be differentiated within the CPT code set.
The ACR urges its members to review and consider how the new code changes may impact their practices.
CPT 2023 CODE SET: NEW CATEGORY I CODES
Three new Category I codes will be available January 1, 2023, and are summarized below.
Percutaneous Arteriovenous Fistula Creation
Two new codes will be available for percutaneous or endovascular approaches for creating arteriovenous anastomoses. There are currently only codes to describe open surgical arteriovenous anastomosis creation.
The new codes will allow the reporting of less invasive approaches utilizing endovascular methods, such as magnets or mechanical capture, to approximate the target vein and artery. The different endovascular procedures may also use balloons or coils to direct blood flow, as well as different imaging methods to guide the endovascular procedure.
Neuromuscular Ultrasound
A new code will be available for reporting comprehensive ultrasound of nerves and accompanying structures. Additionally, the descriptor for code 76882 will be revised to include the phrase “focal evaluation of”. The guidelines in the Extremities subsection will also be revised to clarify the new comprehensive code and limited code 76882.
CATEGORY III CODES: EARLY RELEASE IN 2022
Four new Category III codes were released early to the American Medical Association’s (AMA’s) website on January 1, 2022, with an effective date of July 1, 2022.
CT Tissue Characterization
Two new codes were created to describe quantitative CT tissue characterization, the new codes were structured similarly to existing quantitative ultrasound tissue characterization codes 0689T and 0690T.
Quantitative CT tissue characterization is a new technology that can improve population health strategies and lead to better patient outcomes by using computer algorithms to quantitatively characterize tissues on CT images that could only be subjectively evaluated in the past.
Quantitative MRCP
Two codes are available to describe quantitative MRCP, which will allow the reporting of quantitative evaluation of pancreato-biliary structure anatomy from MR images that produce quantitative data of the biliary tree and pancreatic ducts.
The data can inform radiologist evaluation and interpretation, aid physician decision making, and potentially reduce the time for initiation of targeted treatments and interventions in diseases, such as cholestatic liver disease, chronic pancreatitis, or gallstones.
NEW ARTIFICIAL INTELLIGENCE (AI) TAXONOMY APPENDIX
A new appendix will be added to the CPT 2023 code book that describe various applications of AI, such as expert systems, machine learning, and algorithm-based medical services and procedures.
The new taxonomy will help to improve understanding of AI and clarify how these services are used by physicians or other qualified health professionals (QHPs).
The classification of AI services will be grouped into one of three categories:
- Assistive
- Augmentative
- Autonomous
REVISIONS TO E/M CODES
Additional revisions will be made to the E/M codes in 2023. The revisions are a result of the E/M workgroup’s agreement to standardize the rest of the E/M sections in the CPT code set following the Panel’s acceptance of the revisions to the E/M office or other outpatient E/M codes (99202-99215) for the CPT 2021 code set. During the Panel review, it was noted that two sets of guidelines were available in the 2021 and 2022 code set: one for the office or other outpatient E/M codes and another set for all remaining E/M codes. This created an administrative burden for physicians, QHPs, and coders, who have to divide E/M reporting across separate code families. These revisions are designed to correspond with the rest of the E/M sections in the CPT code set. The following sections outline these upcoming changes.
E/M Services Guidelines
- Revision of the E/M Services Guidelines to reflect changes to the Inpatient and Observation Care Services, Consultations, Emergency Department Services, Nursing Facility Services, Home and Residence Services, and Prolonged Services subsections
- Deletion of the subsection regarding Concurrent Care and Transfer of Care
- Revision of the Levels of Medical Decision Making (MDM) table
Inpatient and Observation Care Services
- Revision of the Hospital Inpatient Services subsection, including the heading and guidelines
- Revision of codes 99221-99223, 99231-99236, 99238, and 99239 to include observation care services
- Revision of the Hospital Inpatient Services subsection, including the heading and guidelines
- Deletion of codes 99217-99220 and 99224-99226
Consultations
- Deletion of codes 99241 and 99251
- Revision of codes 99242-99245 and 99252-99255
- Revision of the Consultations section, including subheadings and guidelines
Emergency Department Services
- Revision of codes 99281-99285
- Revision of the Emergency Department Services subsection guidelines
Nursing Facility Services
- Deletion of code 99318
- Revision of codes 99304-99310
Home and Residence Services
- Deletion of codes 99324-99328, 99334-99337, 99339, 99340, and 99343
- Revision of codes 99341, 99342, 99344, 99345, and 99347-99350
- Deletion of the Domiciliary, Rest Home (eg, Boarding Home), or Custodial Care Services subsection, including guidelines
- Revision of the Domiciliary, Rest Home (eg, Assisted Living Facility), or Home Care Plan Oversight Services subsection, including guidelines
- Revision of the Home Services section, including the heading and guidelines
Prolonged Services
- Creation of two new codes for: (1) prolonged services and (2) prolonged psychotherapy services
- Deletion of codes 99345 and 99355-99357
- Revision of codes 99417 and 99483
- Revision of the Prolonged Service With Direct Patient Contact (Except with Office or Other Outpatient Services) subsection guidelines, Prolonged Clinical Staff Services With Physician or Other Qualified Health Care Professional Supervision guidelines, and the Prolonged Service With or Without Direct Patient Contact on the Date of an Office or Other Outpatient Service heading and guidelines
REVISED CODES
Several codes will be revised in 2023 and are summarized below.
Somatic Nerve Injection
The code descriptors will be editorially revised to include “imaging guidance, when performed” for somatic nerve injection codes 64415-64417 and 64445-64448.
Pulmonary Angiography
Pulmonary angiography code 93568 will be revised to specify that angiography is nonselective and is performed on the pulmonary artery.
Paravertebral Spinal Nerves and Branches
Several changes will be made in the Paravertebral Spinal Nerves and Branches subsection. Guidelines will be revised to clarify the procedures described by codes 64490-64495.
A new table will be added with instructions on the appropriate reporting of these codes, and new instructional parenthetical notes will be added to provide instruction on the unilateral and bilateral reporting of paravertebral facet injection of the T12-L1 and L1-L2 levels or nerves innervating those joints.
In addition, the instructional parenthetical note regarding the reporting of codes 64490-64495, 20552, 20553, and 0213T-0218T and the parenthetical notes following codes 64492 and 64495 that instruct users not to report these codes more than once per day will be deleted.