Anesthesia Coding Alert

Major neurostimulator-related changes, minor E/M time shifts lead the way.

We’ve come to expect the AMA’s annual updates to the CPT^® code set to be numerous and complex, and this year’s 230 additions, 49 deletions, and 70 revisions show that the 2024 updates continue that trend. Not sure where to begin? Start by taking note of the evaluation and management (E/M) code revisions, as well as the neurostimulation code additions and modifications.

Let’s review some of these key changes on the horizon for 2024 to ensure you’re on the path to coding success.

Note Time Range Erased in New E/M Descriptors

This year’s office/outpatient E/M changes are minimal, but that doesn’t mean they are insignificant. CPT^® has decided to remove the time ranges from both the new and established office/outpatient E/M codes and replace them with a single total time amount, which is the lowest number of minutes in the current range for each code. This time “must be met or exceeded” according to the new wording that appears in each of the codes’ descriptors.

For example, 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 …) has a current time range of 15-29 minutes. However, beginning Jan. 1, 2024, the provider must meet or exceed 15 minutes of total service time on the date of the encounter for time-based coding, as indicated by the revised code descriptor: (… When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.).

Why: The changes make the office codes more “consistent with the language of the other timed E/M codes,” explains Melanie Witt, RN, MA, CPC, an independent coding expert based in Guadalupita, New Mexico.

In table form, the changes look like this:

Key: Essentially, “this doesn’t really change how the codes are used, but listing the minimum time instead of a range for each code is probably going to be easier to follow,” says Kelly Loya, CPC, CHC, CPhT, CRMA, CHIAP, associate partner at Pinnacle Enterprise Risk Consulting Services.

What will happen to G2212? One possible result of this change may be the resolution of the dispute between CPT^® and Medicare over the prolonged service threshold times. Basically stated, Medicare created its own code, G2212 (Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure …), as AMA/CPT^® viewed prolonged services as beginning at the minimum time for 99205/99215 and the Centers for Medicare & Medicaid Services (CMS) beyond the maximum. Now that the time ranges for 99205/99215 have been replaced by a threshold at the minimum end of the range, it is possible that Medicare may follow CPT^® rules and adopt +99417 (Prolonged outpatient evaluation and management service(s) time … each 15 minutes of total time …) for prolonged services instead.

CPT^® has also made one other slight change. This change applies to the nursing facility care codes 99306 (Initial nursing facility care, per day, for the evaluation and management of a patient …) and 99307 (Subsequent nursing facility care …), raising their time thresholds by five minutes to 50 and 20 minutes, respectively.

Check Out These New Codes for Neurostimulator Procedures

These codes will debut in CPT^® 2024:

• 61889 (Insertion of skull-mounted cranial neurostimulator pulse generator or receiver, including craniectomy or craniotomy, when performed, with direct or inductive coupling, with connection to depth and/or cortical strip electrode array(s))
• 61891 (Revision or replacement of skull-mounted cranial neurostimulator pulse generator or receiver with connection to depth and/or cortical strip electrode array(s))
• 61892 (Removal of skull-mounted cranial neurostimulator pulse generator or receiver with cranioplasty, when performed)
• 64596 (Insertion or replacement of percutaneous electrode array, peripheral nerve, with integrated neurostimulator, including imaging guidance, when performed; initial electrode array)
• 64597 (Insertion or replacement of percutaneous electrode array, peripheral nerve, with integrated neurostimulator, including imaging guidance, when performed; each additional electrode array …)
• 64598 (Revision or removal of neurostimulator electrode array, peripheral nerve, with integrated neurostimulator)

Analysis: The addition of 61889 through 61892 will make the intracranial neurostimulator set — codes 61850 (Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical) through 61888 (Revision or removal of cranial neurostimulator pulse generator or receiver) — more robust. Likewise, adding 64596 through 64598 will broaden the code set for peripheral nerve neurostimulators, which is currently 64553 (Percutaneous implantation of neurostimulator electrode array; cranial nerve) through 64595 (Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver).

CPT^® 2024 will also premiere these Category III codes:

• 0784T (Insertion or replacement of percutaneous electrode array, spinal, with integrated neurostimulator, including imaging guidance, when performed)
• 0785T (Revision or removal of neurostimulator electrode array, spinal, with integrated neurostimulator)
• 0786T (Insertion or replacement of percutaneous electrode array, sacral, with integrated neurostimulator, including imaging guidance, when performed)
• 0787T (Revision or removal of neurostimulator electrode array, sacral, with integrated neurostimulator)
• 0788T (Electronic analysis with simple programming of implanted integrated neurostimulation system (eg, electrode array and receiver), including contact group(s), amplitude, pulse width, frequency (Hz), on/off cycling, burst, dose lockout, patient-selectable parameters, responsive neurostimulation, detection algorithms, closed-loop parameters, and passive parameters, when performed by physician or other qualified health care professional, spinal cord or sacral nerve, 1-3 parameters)
• 0789T (… 4 or more parameters)

Remember, Category III codes, depicted with four numbers and the letter T, are temporary codes that represent new technologies, services, and procedures.

Review These Descriptor Revisions

Keep an eye out for the handful of changes pertaining to CPT^® codes for neurostimulator insertion and revision/removal, effective Jan. 1, 2024. Here’s a look at these codes:

(What’s being deleted is struck through; what’s being added is underlined and in bold.)

• Current descriptor: 63685 (Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling)
• Revised descriptor: 63685 (Insertion or replacement of spinal neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver)
• Current descriptor: 63688 (Revision or removal of implanted spinal neurostimulator pulse generator or receiver)
• Revised descriptor: 63688 (Revision or removal of implanted spinal neurostimulator pulse generator or receiver, with detachable connection to electrode array)
• Current descriptor: 64590 (Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling)
• Revised descriptor: 64590 (Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver)
• Current descriptor: 64595 (Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver)
• Revised descriptor: 64595 (Revision or removal of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, with detachable connection to electrode array)