General Surgery Coding Alert

CPT^® 2022 changes the descriptor for 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional) by dropping the phrase “Usually, the presenting problem(s) are minimal.”

“The reason for the deletion is an editorial revision to bring the descriptor for 99211 more into line with the rest of the office/outpatient evaluation and management (E/M) codes. The descriptors for those codes prior to 2021 all included a sentence that read, ‘Usually, the presenting problem(s) are....’ Now, they don’t,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

With the phrase removal, 99211’s descriptor is now more synched with the other office/ outpatient E/Ms: 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. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter).

“This change also removes a potential source of confusion,” says Cindy Hughes, CPC, CFPC, consulting editor of Cindy Hughes Consulting in El Dorado, Kansas. “For instance, 99211 may be reported when a nurse provides education to a newly diagnosed diabetic, but diabetes is by no means a minimal problem.”

In other words, even with the change, “99211 still represents an E/M (really an assessment and management) service provided by clinical staff as opposed to a physician or other qualified healthcare professional who may report higher levels of E/M services. Services described by 99211 must be medically necessary (i.e., clinically indicated) and be part of a plan of care by a physician or other qualified healthcare professional. This is why 99211 is not reportable for measuring a patient’s blood pressure at their request rather than per an established plan of care,” Hughes elaborates.

Embrace CCM Code Revisions

CPT^® 2022 makes some less drastic — but still important — changes to several chronic care management (CCM) codes in 2022. Here’s a rundown of the 2022 versions of each code (additions underlined, deletions strikethrough), along with the 2021 descriptors and some analysis as to how the codes will be different:

99490 (Chronic care management services with the following required elements:

• multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
• chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
• comprehensive care plan established, implemented, revised, or monitored; first 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.)

The difference: CPT^® 2022 adds “that” between “conditions” and “place,” which is a superficial edit designed to give the descriptor more clarity. Because 99490 is a parent code for +99439 (…each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure), the change runs with the add-on code.

99491 (Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month, with the following required elements:

• multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,;
• chronic conditions that place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline,;
• comprehensive care plan established, implemented, revised, or monitored.;first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.)

The difference: As with 99490, CPT^® 2022 adds “that” between “conditions” and “place” to 99491 for clarity. But the biggest change is the rearrangement of the code to make it a parent for a new add-on code. By changing semi-colons to commas and moving “first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.” to the end of the descriptor following a semicolon, the code now parallels the format of 99490 and allows the addition of new code +99437 (… each additional 30 minutes by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)).

Keep complex CCM similar: You should be ready for the same change to complex chronic care management code come Jan. 1:

99487 (Complex chronic care management services with the following required elements:

• multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
• chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
• comprehensive care plan established, implemented, revised, or monitored,
• moderate or high complexity medical decision making; first 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.)

The difference: As with 99490, +99439, 99491, and +99437, CPT^® 2022 adds “that” between “conditions” and “place” in the descriptors for 99487 and the related add-on child code +99489 (…each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)).