Pulmonology Coding Alert

Prepare to revise the way you report 99211.

Are you nervous that you’ll have to utilize a slew of new CPT^® codes and revisions in 2022? Well, as a pulmonology coder, you can breathe a sigh of relief. The CPT® code set for next year is out, and you won’t find many codes specifically relating to pulmonology. However, the American Medical Association (AMA) also revised a standard evaluation and management (E/M) code, delivered new principal care management codes, and revised several chronic care management codes that take effect January 1, 2022 — so you should take note of these changes as well to avoid denials.

Take a look at what changes are ahead in CPT^® 2022.

Watch Out for a Major E/M Revision

One of the most common CPT^® codes used by pulmonology coders is 99211, and starting January 1, 2022, you’ll find new verbiage to the code descriptor. The change may seem minor, but the AMA doesn’t alter the descriptors without a reason. If you’re not careful, a single word change in a code descriptor could spell disaster for your claim.

As the calendar turns to 2022, code 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. Usually, the presenting problem(s) are minimal.) will have a small descriptor change. The 2022 CPT^® code set deletes “Usually, the presenting problem(s) are minimal.”

“The reason for the deletion is an editorial revision to bring the descriptor for 99211 more into line with the rest of the office/outpatient evaluation and management (E/M) codes (99202-99215). The descriptors for those codes prior to 2021 all included a sentence that read, ‘Usually, the presenting problem(s) are....’ Now, they don’t,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

CPT^® code 99211 still represents an E/M service that’s provided by clinical staff as opposed to a physician or other qualified health professional. This code may be reported when a nurse provides the patient with education on how to use an inhaler for a recently diagnosed asthmatic.

“Keeping abreast of code changes can be important to your practice’s bottom line,” says Melanie Witt, RN, MA, an independent coding consultant from Guadalupita, New Mexico.

Symbolic change: Another adjustment to 99211 for 2022 is that the code will also carry a telemedicine symbol. This indicator allows you to report the code if the criteria for telemedicine are met.

Understand New Principal Care Management Codes

January 1, 2022 brings a new family of codes for principal care management services (PCM). According to Carol Pohlig, BSN, RN, CPC and Manager, Coding & Education in the Department of Medicine at the Hospital of the University of Pennsylvania in Philadelphia, the new PCM codes align with CMS-recognized HCPCS codes G2064-G2065 (Comprehensive care management…), which are already established.

The new PCM codes include:

• 99424 (Principal care management services, for a single high-risk disease, with the following required elements: one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death, the condition requires development, monitoring, or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen and/or the management of the condition is unusually complex due to comorbidities, ongoing communication and care coordination between relevant practitioners furnishing care; first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.)
• +99425 (…; each additional 30 minutes provided personally by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)
• 99426 (…; first 30 minutes of clinical staff time directed by physician or other qualified health care professional, per calendar month.)
• +99427 (…; each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)

Will CMS will adopt usage of the new CPT^® codes (99424-99427) or stick with the G-codes? “It’s unclear,” Pohlig says. “Practices that currently report PCM services under the G-codes, would continue to report these services, and may be able to expand these services to private payers.”

Reimbursement is available “for care management of patients with a single chronic condition, whereas previously such services were reimbursed only for patients with multiple chronic conditions,” says Nick Hut, Senior Editor of Healthcare Financial Management Association in a blog post (URL: www.hfma.org/topics/revenue-cycle/article/ama-releases-2022-cpt-code-set-with-new-options-that-apply-to-co.html).

Specialists, such as pulmonologists, can use the PCM codes and they’re not required to take on complete care of the patient for unrelated diagnoses. The major aim of PCM services is to help improve care for patients with complicated conditions while keeping them out of the emergency room and hospital.

Don’t miss: Code +99425 is an add-on code that you can report with primary code 99424. Additionally, code +99427 is an add-on code you can use with primary code 99426 if the requirements are met.

Find Out Which Chronic Care Management Codes Receive Edits

Chronic care management services are also included in the 2022 CPT^® code set. In 2022, four codes resequenced include:

• 99490 (Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions that place the patient at significant risk of death, acute exacer­bation/decompensation, or functional decline, compre­hensive care plan established, implemented, revised, or monitored; first 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.)
• +99439 (…; each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure))
• 99491 (Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,; chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,; comprehensive care plan established, implemented, revised, or monitored.; first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.)
• +99437 (…; each additional 30 minutes by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure))

If you look at the descriptor for 99491, you’ll notice a portion of the wording has been deleted while another section was added. The added phrasing, “first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month” has been moved and edited for conciseness.

Plus, +99439 and +99437 are add-on codes you can use with primary codes 99490 and 99491, respectively.