Cardiology Coding Alert

Say goodbye to 99441 through 99443 next year.

When CPT^® 2025 becomes effective on Jan. 1, 2025, you won’t see any new CPT^® Category I codes specifically for cardiology next year, but you will see plenty of new evaluation and management (E/M) options. You should also see several minor E/M revisions and a few cardiology deletions.

Read on to learn how to prep your practice for next year.

Mark Down Brand-New E/M Codes

Next year, you will see eight new synchronous audio-video visit codes added. For example, you will gain 98000 (Synchronous audio-video 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 total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.) through 98003 (… high medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.)

You will also see eight new synchronous audio-only visit codes added, such as 98008 (Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.) through 98015 (… high medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.)

New patients: You will report 98000 through 98003 for synchronous audio-video visits and 98008 through 98011 (… high medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.) for synchronous audio-only visits for new patients, according to the code descriptors.

Established patients: On the other hand, report 98004 (Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.) through 98007 (… and high medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.) for synchronous audio-video visits and 98012 (… straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 10 minutes must be exceeded.) through 98015 for synchronous audio-only visits for established patients.

As you can see from the code descriptors, when using total time on the date of the encounter for code selection, each of these new codes requires that a certain amount of time be met or exceeded. For example, 98000 requires a minimum of 15 minutes. On the other hand, the physician must meet or exceed 40 minutes to report 98007.

Additionally, for codes 98008 through 98015, the code descriptors mandate that along with the medically appropriate history and/or exam and the appropriate level of medical decision making (MDM), there must also be more than 10 minutes of medical discussion.

Each of these new codes also designates a type of MDM required. For example, for 98012, that is straightforward MDM. On the other hand, for 98011, that is high MDM.

Don’t miss: You will also see 98016 (Brief communication technology-based service (eg, virtual check-in) by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation and management service provided within the previous 7 days nor leading to an evaluation and management service or procedure within the next 24 hours or soonest available appointment, 5-10 minutes of medical discussion) in 2025.

“These changes take effect Jan. 1, 2025. The sooner we prepare our providers and electronic health records (EHRs) the better,” says Robin Peterson, CPC, CPMA, senior consultant; compliance review, education, and training, Pinnacle Enterprise Risk Consulting Services in Centennial, Colorado. “We can take this time to talk with our providers about the changes and how they will impact them and the practice. We can also use this time to update our EHRs to ensure the proper codes are ready to use for the new year.”

Focus on Minor E/M Revisions

Some of the E/M codes will also gain revisions in 2025. First, the education and training codes 98960 through 98962 will add a small change to their descriptors.

For example, for 98960, the new descriptor will be (Education and training for patient self-management by a qualified, nonphysician qualified health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient) Emphasis added.

As you can see, the order of the words “nonphysician” and “qualified” will be switched.

You will also see some changes to telephone assessment codes 98966 through 98968.

For example, for 98966, the new descriptor will be (Telephone assessment and management service provided by a qualified nonphysician qualified health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion). The order of the words “nonphysician” and “qualified” will be switched for these codes.

Additionally, you will see changes to E/M codes 98970 through 98972.

For example, the new descriptor for 98970 will be (Qualified Nonphysician qualified health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes). The order of the words “nonphysician” and “qualified” will also be switched for these codes.

Remember to Delete These Options

You will also lose the following cardiology codes next year:

• 33471 (Valvotomy, pulmonary valve, closed heart, via pulmonary artery)
• 33737 (Atrial septectomy or septostomy; open heart, with inflow occlusion)
• 33813 (Obliteration of aortopulmonary septal defect; without cardiopulmonary bypass)

In 2025, you will no longer be able to report E/M codes 99441 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion) through 99443 (… 21-30 minutes of medical discussion).