Pulmonology Coding Alert

Learn how COVID-19 codes have been consolidated.

The AMA released the 2024 CPT^® code set on Sept. 8, 2023, and it contains 230 new codes, 70 revisions, and 49 deletions. Pulmonology coders will want to pay close attention to the revised codes, as evaluation and management (E/M) codes take center stage once again.

Pulmonology Coding Alert reviewed the new CPT^® code set to provide you with the code changes you’ll need to know by Jan. 1, 2024.

Clock in for More E/M Changes

Over the last few years, the AMA has made extensive changes to the CPT^® evaluation and management (E/M) codes and guidelines, and 2024 will also see additional changes. However, you’ll be relieved to know that next year’s E/M changes are minimal. But that doesn’t mean they’re insignificant.

Effective Jan. 1, 2024, new and established office/outpatient E/M codes no longer have time ranges and will instead feature a single total time amount for each code. The total time amount is the minimum number of minutes in the current E/M code descriptor ranges, and the time must be “met or exceeded” according to the new code descriptors.

Examine the descriptor differences between 2023 and 2024 below:

• 2023: “total time … spent on the date of the encounter”
• 2024: “total time on the date of the encounter” that “must be met or exceeded”

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 before you can bill this code by time.

In table form, the changes look like this:

The AMA’s decision to change the office/outpatient E/M time requirements from a range to a minimum number of minutes reflects Medicare policy. “This revision safeguards providers from using CPT^® language that is inconsistent with Medicare policy. Medicare does not permit time ranges to be documented for certain services, and wants a specific amount (e.g., integer) of time identified in the documentation,” says Carol Pohlig, BSN, RN, CPC, manager of coding and education in the department of medicine at the Hospital of the University of Pennsylvania in Philadelphia.

Note: CPT^® will not be changing the descriptor to 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), which you will continue to bill for established patients receiving E/M services from a nurse practitioner (NP), a physician assistant (PA), or any other nonphysician practitioner (NPP). The code will also continue to require no level of medical decision making (MDM) or total time for you to document.

Report RSV Vaccine Administration

The 2023 CPT^® code set saw the first respiratory syncytial virus (RSV) vaccine additions, and 2024 will see three more RSV vaccine codes. You’ll assign one of the following codes for RSV vaccine administrations effective January 1:

• 90380 (Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscular use)
• 90381 (… 1 mL dosage, for intramuscular use)
• 90683 (Respiratory syncytial virus vaccine, mRNA lipid nanoparticles, for intramuscular use)

“The big differences between these codes are the dosages and the product composition. Codes 90380-90381 represent the monoclonal antibody, which is used primarily for infants until they can build better immunity. On the other hand, 90683 is an mRNA lipid nanoparticle vaccine, which is similar to the COVID-19 vaccine’s composition, but the vaccine is not currently available,” Pohlig says.

Take note: Code 90683 is awaiting U.S. Food & Drug Administration (FDA) approval. Once the FDA approves the product, providers may start reporting the code to receive reimbursement for the vaccine.

The codes listed above join 90678 (Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use) and 90679 (Respiratory syncytial virus vaccine, preF, recombinant, subunit, adjuvanted, for intramuscular use), which were added to the CPT^® code set in 2023. These vaccines are recommended for people ages 60 years and older.

Important: Remember to include an appropriate vaccine administration code, such as 90471 (Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)).

Look for Consolidated COVID-19 Vaccine Codes

While the end of the COVID-19 public health emergency (PHE) was declared in May 2023, the need for updated COVID-19 vaccines remains, and the 2024 CPT^® code set reflects that need. In fact, the AMA made the following five codes effective on Sept. 11, 2023:

• 91318 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 3 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use)
• 91319 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 10 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use)
• 91320 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use)
• 91321 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 25 mcg/0.25 mL dosage, for intramuscular use)
• 91322 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 50 mcg/0.5 mL dosage, for intramuscular use)

Each of these codes join 91304 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5 mL dosage, for intramuscular use), which is currently in effect. The code’s descriptor is receiving a minor revision as, effective Sept. 11, 2023, the words “preservative free” were deleted from 91304’s descriptor.

Since the AMA made these codes effective after releasing the 2024 CPT^® code set, the codes will be published in the 2025 CPT^® code set.

Formula: The new codes represent a monovalent component that corresponds to the COVID-19 Omicron variant XBB.1.5 and differentiate the manufacturer. Codes 91318-91320 were approved for Pfizer vaccine products, and codes 91321-91322 are for Moderna products.

You’ll also notice that more than 50 codes related to COVID-19 immunizations have been consolidated in the 2024 CPT^® code set. The codes that will be deleted include vaccination products and vaccine administration codes, and the AMA is establishing 90480 (Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, single dose) for reporting COVID-19 vaccination administrations. You will use this code with any of the vaccine codes mentioned above.