Otolaryngology Coding Alert

How much do you remember about these major changes from the last 12 months?

Whether you’re a new or seasoned coder, it can be challenging to keep up with all the coding updates that have been rolled out over the past year. There’s a lot to keep straight, and inevitably, it takes some time to process them all.

So, to help, we’ve recapped three of the biggest changes in coding practices from 2023, so you can hit the ground running in 2024.

Don’t Forget to Use Modifier JZ for Part B Drugs

If your practice supplies and reports the drugs administered to Medicare Part B patients, you should be familiar with using modifier JW (Drug amount discarded/not administered to any patient) when the provider administers part of a single-dose container and discards the rest. Reporting the discarded amount with modifier JW and the number of units wasted allows you to receive payment from Medicare Part B for the portion not administered.

When the calendar flipped to July 1, 2023, a new requirement went into effect. You now need to use the novel, related modifier JZ (Zero drug amount discarded/not administered to any patient) when there is no discarded amount from a single-dose container subject to modifier JW rules. You should submit either JW or JZ, depending on whether or not there is any drug wasted following administration.

Tip: Modifier JZ goes on one claim line with the HCPCS Level II code for the drug administered and the number of units given to the patient.

Recall the Updates to the Remainder of E/M Sections

Coding and documentation for E/M services carry fewer administrative burdens in 2023 as landmark reforms that were implemented in 2021 for E/M services performed in outpatient and office settings have been carried over across all healthcare settings, including hospitals, emergency departments, nursing facilities, and patient homes.

Remember: Changes to E/M coding in 2021 included providing physicians the flexibility to select a level of service for an outpatient visit based on the complexity of medical decision making (MDM) or total time on the day of service — including work completed when the patient wasn’t present.

In one fell swoop, CPT^® got rid of its per-day initial and subsequent outpatient hospital observation codes for services spanning over multiple dates. Instead, you should now be using one of the existing inpatient hospital care codes, which received extensive descriptor revisions, allowing you to use MDM or time to guide code selection.

Initial inpatient/observation care: 99221-99223 (Initial hospital inpatient or observation care, per day which requires a medically appropriate history and/or examination and straightforward or low/moderate/high level medical decision making …)

Subsequent inpatient/observation care: 99231-99233 (Subsequent hospital inpatient or observation care, per day … which requires a … low/moderate/high level of medical decision making …)

CPT^® 2023 also updated the following E/M codes:

• 99282-99285 (Emergency department visit …)
• 99242-99245 (Office or other outpatient consultation …)
• 99234-99236 (Hospital inpatient or observation care … including admission and discharge on the same date …)

Impact: With CPT^® 2023 removing all references to level of history and physical examination from the rest of the E/M code descriptors and replacing them with a “medically appropriate” history and exam, the note can home in on the presenting problem instead of the three key components. This shift in focus means it is no longer necessary to include extraneous information not relevant to the medical issues at hand in the documentation. Instead, efforts should be geared toward supporting the E/M level based on MDM or total time, bringing the codes of the remainder of E/M services in line with the office/outpatient E/M codes.

Exception: Time-based code selection does not apply to emergency department (ED) codes — the level of an ED service is based solely on MDM.

Take Note of Another Wave of New Z Codes

ICD-10 2024 brought significant change to Chapter 21, Factors Influencing Health Status and Contact with Health Services, with 30 new codes and six codes converted to parent. These Z codes encompass various aspects such as personal history of military service, newborn observation for suspected conditions ruled out, carriers of bacteria (Acinetobacter baumannii, Enterobacterales), family history of certain colonic polyps, and caregiver noncompliance.

The 2024 update also enhanced the Social Determinants of Health (SDoH) section, providing you with more ways to report notable child-guardian relationships, thanks to new codes like Z62.23 (Child in custody of non-parental relative) and Z62.823 (Parent-step child conflict).