ED Coding and Reimbursement Alert

Every coder who’s ever leafed through a CPT^® code book is familiar with a variety of marks and symbols printed next to, under, and above the codes and descriptors in the book. These symbols are in place to help you navigate the rules around each code, but they may actually have the opposite effect — confusion — if you don’t know what they mean.

Read on to get a comprehensive look at what each CPT^® code book symbol means and how you can use them to help simplify your code selection in the future.

Note: Most of the codes mentioned in this article are not ED-relevant, but the symbols beside them are. The examples will illustrate how to recognize these symbols when they are applied to ED-relevant codes.

Know New Codes by •

Every year, coders eagerly await new code additions to the code set, and the best way to identify them is to look for the large red dot that’s printed next to the newly debuted codes in the code book.

For example, in 2024, the AMA debuted 81457 (Solid organ neoplasm, genomic sequence analysis panel, interrogation for sequence variants; DNA analysis, microsatellite instability). In the CPT^® code book, this code is among those with the red bullet printed next to them.

Find Revised Codes With ▲

In addition to deleting and debuting new codes in each annual edition of the CPT^® code book, revisions also occur every year. This typically happens when the AMA finds the need to change a code descriptor, often to include new technologies or clarifications of how the code should be used.

For instance, in 2024, the word “indwelling” was replaced by the word “implanted” in the descriptor for 9 (Chemotherapy administration into the peritoneal cavity via implanted port or catheter). For that reason, the AMA placed the blue triangle symbol next to the code in the CPT^® code book.

Watch  for Modifier 51 Exemptions

There are certain codes that can warrant extra pay from insurers with the use of modifier 51 (Multiple procedures). Payers add this modifier when additional pay is acceptable with a certain code pair, but that’s not always possible. In cases when you won’t be able to collect extra for a second procedure, CPT^® uses the universal prohibition symbol — a circle with a diagonal line from upper left to lower right.

For instance, 33509 (Harvest of upper extremity artery, 1 segment, for coronary artery bypass procedure, endoscopic) is a modifier 51 exempt code, according to the 2024 edition of CPT^®.

Look to ✚ for Add-on Codes

An add-on code is a CPT^® coding option that cannot be reported on its own, and must instead be billed along with a parent code or it won’t be payable. To ensure coders know which codes fall into this category, the CPT^® code book print uses a plus symbol next to the add-on codes.

For example, +99459 (Pelvic examination (List separately in addition to code for primary procedure)) was introduced in 2024 as an add-on code that can be billed along with another service. The code book includes the plus symbol next to it.

Locate Out-of-Sequence Codes With #

When a code appears out of sequence in the CPT^® code book, you’ll see the pound sign/hashtag listed next to it. This is a code that is listed along with other related codes, even though it doesn’t numerically come after the codes before and after it.

For example, 43270 (Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)) has the pound sign next to it. That’s because it’s listed after 43257 and before 43259, so it feels like it shouldn’t make sense for it to be listed there. The symbol tells you that the AMA sequenced it the way it did on purpose.

Let  Direct You to Items Pending FDA Approval

Not every code in your manual is assigned to products that have been approved by the Food & Drug Administration (FDA). Particularly in the case of vaccines, the AMA will sometimes assign a code to a vaccine product in anticipation of an upcoming FDA approval. In these cases, the code is marked with a lightning symbol next to it.

For example, you’ll find the lightning symbol next to code 90666 (Influenza virus vaccine (IIV), pandemic formulation, split virus, preservative free, for intramuscular use) in CPT^® 2024.

Follow  for Beginning and End of Text Changes

Not every change in the CPT^® code book involves a new, deleted, or revised code or descriptor. In some cases, you’ll find new guidance listed below a code descriptor, and in those cases, the new text will be marked with arrows denoting where new text starts and ends.

For example, under 81456 (Solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes, genomic sequence analysis panel, interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis), CPT^® added new text that said >For genomic sequence RNA analysis using a separate method, see 81449, 81451, 81456.

The arrows alert coders that this instruction is new and that they should take note of the latest guidelines so they apply the codes correctly going forward.

Torrey Kim, Contributing Writer, Raleigh, N.C.