Orthopedic Coding Alert

CPT^® changed descriptors to mirror other E/M codes.

The new CPT^® code book will feature revisions to all of the office/outpatient evaluation and management (E/M) codes.

This means that all the codes in the 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.) range will look different in 2024.

“They made the change to be consistent with the language of the other timed E/M codes,” says Melanie Witt, RN, MA, CPC, an independent coding expert based in Guadalupita, New Mexico. Read on to check out the details on these descriptor changes.

Time Range Erased in New Descriptors

The descriptor for the time element has been revised, as you’ll see in the current and new 99202 descriptors below (What’s being deleted is underlined and struck through; what’s being added is underlined and in bold.)

Current descriptor: 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.)

Revised descriptor: 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 total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.)

The other office/outpatient E/M codes will change similarly; here’s a look at what’s changing in each of these codes in 2024:

• 99203 (… When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.)
• 99204 (…When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.)
• 99205 (… When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.)
• 99212 (… When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.)
• 99213 (… When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.)
• 99214 (… When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.)
• 99215 (… When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.)

Analysis: The new language clarifies that you can use all of the time spent on that patient when leveling your E/M — but only on the date of the encounter.

Comment: Also, the updated E/Ms descriptors makes them “more consistent with the rest of the code sets,” says Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania. This is evidenced by codes like 99221 (Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/ or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.) or 99234 (Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.), which have time minimums, but not time ranges.

“Per the AMA, the codes’ time ranges will be replaced with threshold times, which will bring them in line with the rest of the level-based code set,” explains Falbo. “This is what they have done for the inpatient code sets.”