Once again, the American Medical Association’s (AMA) Current Procedural Terminology (CPT) Editorial Panel released changes to the CPT and HCPCS coding structure. Many of the newly recommended codes have been created as a result of bundling mandates or identified as potentially “misvalued” services. The changes are in effect as of January 1, 2021.
Indeed the most far-reaching changes are to the Evaluation and Management (E/M) codes that affect office visits in every specialty as well as primary care. Because of the impact of the Centers for Medicare and Medicaid Services (CMS) fee schedule conversion factor, cardiology will see an overall negative impact on revenue.
However, the Omnibus COVID Relief Deal signed on December 27, 2020, boosts the Medicare Physician Fee Schedule for a one-year 3.75% increase. This one-time increase adjusts for the effects of the physician fee schedule budget neutrality rules and is intended to provide relief to physicians during the COVID-19 public health emergency.
2021 Medicare Physician Fee Schedule
CMS released the 2021 Medicare Physician Fee Schedule outlining payment on all Medicare tests and procedures. One big change that has many concerned is the Finalized Conversion Factor of $31.41 (a $3.68 decrease from 2020). While this recognizes a budget neutrality adjustment required by law to offset the changes meant to benefit primary care providers, it has created serious concern for specialty care providers, including cardiology, who will take the financial hit. This decrease is a result of revisions to the relative value units (RVUs) for E/M services that have gone through a major overhaul.
Evaluation and Management Codes
The editorial panel has approved significant revisions to the E/M code descriptors. In fact, this is the first major overhaul to E/M reporting in over 25 years.
These changes include:
- Eliminating history and physical exam requirements for service level selection.
- Allowing physicians to choose between medical decision-making (MDM) or total time to determine E/M.
- Modifying MDM criteria to affect the management of a patient’s condition.
According to the AMA, these changes will:
- ensure payment levels for outpatient E/M visit codes are resource-based,
- minimize the need for audits, and
- more accurately reflect the services provided.
As part of the new E/M code structure, there will be a new add-on code created to report additional provider time in 15-minute increments. This new add-on code will be reported with codes 99205 and 99215.
Other changes include:
- New patient code 99201 will be deleted
- New patient codes 99202, 99203, 99204, and 99205, and established patient codes 99211, 99212, 99213, 99214, and 99215 codes will be editorially revised
- Prolonged services codes 99354, 99355, and 99356 will also be revised to reflect these changes.
According to the AMA, “history and/or physical examination as a component for code selection will be eliminated; code level selection will be based on medical decision making (MDM) or time. There will also be changes in the definition of MDM and time when used with these codes. The E/M guidelines will be revised extensively to reflect these changes.”
The 2021 CPT includes three new shunting codes for congenital cardiac issues, as well as clarification on some ventricular assist device codes:
- Code 33741 is for transcatheter septostomy to create effective arterial flow. The procedure includes imaging guidance when performed. A diagnostic cardiac catheterization is not typically performed during this procedure; therefore, it can be reported separately when performed.
- Code 33745 is for transcatheter intracardiac shunt creation using a stent for effective intracardiac flow. The procedure includes intracardiac stent placement, target zone angioplasty, diagnostic cardiac catheterization, and imaging guidance when performed.
- Code 33746 is an add-on code for use with 33745 for each additional shunt location.
- Codes 33990, 33991 – Insertion of ventricular assist device codes – specify that the procedure involves the left heart. There is now a new code:
- 33995 Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; right heart, venous access only reports the insertion of ventricular assist device in the right heart.
- Code 33992 is revised to report the removal of the ventricular assist device from the left heart.
- New code 33997 – Removal of percutaneous right heart ventricular assist device, venous cannula, at separate and distinct session from insertion reports the removal of a ventricular assist device from the right heart.
Percutaneous Core Needle Lung Biopsy
Code 32405 – Under Excision/Resection Procedures of the Lungs and Pleura will be deleted and replaced with a new code that bundles percutaneous core needle lung biopsy with imaging guidance when performed.
Specifically, Codes 32405 and 77012 were identified by the editorial panel as code pairs being performed together 75% or more of the time and it was recommended that they be bundled.
A Final Thought
With cardiology reimbursement facing added strain, there has never been a better time to consider a third-party partnership for your coding and billing process. With a partner coding team, you can rest assured that changes have been thoroughly researched and reviewed and any possible modifications or adaptations are implemented immediately.