Ob-Gyn Coding Alert

Say goodbye to 99441 through 99443 next year.

When CPT^® 2025 becomes effective on Jan. 1, 2025, you will see plenty of new evaluation and management (E/M) options. You should also see several minor E/M revisions.

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

First, the CPT^® 2025 E/M Guidelines Have Changed

When you review the CPT^® description for the E/M codes 99202-99499, you’ll see a change both to the codes specified as well as the instructions themselves. See below:

Delete These Telephone E/M Codes

If your ob-gyn performs a E/M service for an established patient via telephone, you’ll need to strike off these three codes from your list:

• 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)
• 99442 (… 11-20 minutes of medical discussion)
• 99443 (… 21-30 minutes of medical discussion)

Instead, if you want to report a similar service, CPT^® 2025 directs you to look at codes 98008-98016.

Synchronous Audio-Video Visit Codes Get New 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 a new 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, 98012 requires straightforward MDM. On the other hand, 98011 requires 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 of compliance review, education, and training at 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 electronic health records 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.

Don’t Miss These Language Changes to Current E/M Codes

CPT^® 2025 has also changed the wording of some E/M codes, which either adds observation services, changes the level of decision making, or clarifies the amount of time the ob-gyn must spend if you’re billing based on time. Review the chart below and pay attention to the emphasis added to the CPT^® 2025 code descriptors:

Don’t Miss These Note Changes

For prolonged outpatient E/M code 99417 (Prolonged outpatient evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (List separately in addition to the code of the outpatient Evaluation and Management service), you’ll see that the Notes under the code in your CPT^® 2025 manual has changed. See below:

Additionally, you’ll see a Note change to team conference codes 99366-99368:

Finally, additional Note changes pertaining to multidisciplinary codes 99374-99380 are as follows:

Suzanne Burmeister, BA, MPhil, Medical Writer and Editor