Oncology & Hematology Coding Alert

Major chemo changes, minor E/M time shifts lead the way.

The annual updates to the CPT^® code set are always numerous and complex, and this year’s 230 additions, 49 deletions, and 70 revisions show that the 2024 updates are no different. In oncology, you’ll need to pay particular attention to the numerous path/lab code additions and changes, as well as critical revisions to the chemotherapy codes.

Here’s a brief glimpse of what you can expect, so you can hit the ground running on Jan. 1, 2024.

Check These Chemo Code Changes

As an oncology coder, the first major changes you should take note of can be found in the medicine chapter of CPT^®. There, you will find a revision to 96446 (Chemotherapy administration into the peritoneal cavity via indwelling port or catheter), where the word “indwelling” has now been replaced by the word “implanted.”

More important, there are two code additions for intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC), a combination procedure where a provider first removes tumors surgically, then applies heated chemotherapy medication directly to the patient’s peritoneal cavity. The codes are +96547 (Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; first 60 minutes (List separately in addition to code for primary procedure)) accompanied by another add-on, +96548 (… each additional 30 minutes (List separately in addition to code for primary procedure)) for extended service time. As these codes are both add-on codes, you can only report them with a relevant primary procedure code.

Make Note of These Small E/M Time Changes

After the extensive changes CPT^® made to the evaluation and management (E/M) codes and guidelines over the last few years, you’ll be relieved to know that this year’s E/M changes are minimal. For 2024, 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 new code descriptor (emphasis added): (… 15-29 minutes of total time is spent on the date of the encounter minutes must be met or exceeded.).

In table form, the changes look like this:

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 to the dispute between CPT^® and Medicare over the prolonged service threshold times that we reported on in Oncology & Hematology Coding Alert, Vol. 25, No. 1. Basically stated, Medicare created their 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 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. Stay tuned to Oncology & Hematology Coding Alert for further information.

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. “It will be important for oncology or hematology providers to know these new, higher thresholds if they are seeing patients in a nursing facility,” Loya notes.