Pulmonology Coding Alert

Brief check-ins also receive a code.

While the Pulmonary section of the CPT^® code set will receive only minimal code revisions in 2025, you’ll need to prepare for the new code year by familiarizing yourself with new telemedicine evaluation and management (E/M) codes.

Read on to learn about these new codes, so you’re prepared on January 1.

View New Telemedicine Video Service Codes

Next year, you’ll see eight new synchronous audio-video E/M visit codes added. The differences between the codes are related to new vs. established patients, level of medical decision making (MDM), and time spent with the patient. Like other E/M visit codes, you have the option of billing for MDM or the total time on the date of the encounter.

For telemedicine video calls with new patients, you’ll assign one of the following codes:

• 98000 (Synchronous audio-video 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.)
• 98001 (… low medical decision making … 30 minutes must be met or exceeded.)
• 98002 (… moderate medical decision making … 45 minutes must be met or exceeded.)
• 98003 (… high medical decision making … 60 minutes must be met or exceeded.)

For telemedicine video calls with established patients, you’ll assign one of the following codes:

• 98004 (Synchronous audio-video visit for the evaluation and management of an established 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, 10 minutes must be met or exceeded.)
• 98005 (… low medical decision making … 20 minutes must be met or exceeded.)
• 98006 (… moderate medical decision making … 30 minutes must be met or exceeded.)
• 98007 (… high medical decision making … 40 minutes must be met or exceeded.)

Codes 98003 and 98007 feature instructional notes instructing you to use +99417 (Prolonged outpatient evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (List separately in addition to the code of the outpatient Evaluation and Management service)) for an audio-video call that lasts 75 minutes or longer.

Recognize Audio-Only E/M Service Codes

The E/M services will also add synchronous audio-only visit codes for new and established patients starting in 2025. Synchronous audio-only visits are also known as telephone calls. Again, similar to the synchronous audio-video visit codes, you have the option of billing for MDM or the total time on the date of the encounter.

For synchronous audio-only visits with new patients, you’ll assign one of the following:

• 98008 (Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.)
• 98009 (… low medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.)
• 98010 (… moderate medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.)
• 98011 (… high medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.)

For synchronous audio-only visits with established patients, you’ll assign one of the following:

• 98012 (Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 10 minutes must be exceeded.)
• 98013 (… low medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.)
• 98014 (… moderate medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.)
• 98015 (… high medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.)

Important: Like the synchronous audio-video codes 98003 and 98007, instructional notes following 98011 and 98015 instruct you to use prolonged services code +99417 (if the synchronous audio-only visit extends past a set amount of time, as the following table illustrates:

Additionally, CPT^® is adding 98016 (Brief communication technology-based service (eg, virtual check-in) by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation and management service provided within the previous 7 days nor leading to an evaluation and management service or procedure within the next 24 hours or soonest available appointment, 5-10 minutes of medical discussion) to the code set to report patient-initiated check ins for established patients only.

According to the CPT^® guidelines, this service is “intended to evaluate whether a more extensive visit type is required.”

Note: It is imperative to monitor payer acceptance of any new CPT^® code. CPT^® code existence does not mean automatic payer acknowledgement or reimbursement for the code.

Seek Out the Ventilator Management Guideline Revision

The Pulmonary section of the CPT^® code set will not see any major changes when the calendar flips to 2025. In fact, the only revision listed in this section is a parenthetical note under the ventilator management codes.

You’ll find the instructional note that follows 94002-94004 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing …) has been revised to include the new telemedicine-related codes listed above. The note now reads:

Do not report 94002-94004 in conjunction with evaluation and management services 98000-98016, 99202-99499 [emphasis added.]

Mike Shaughnessy, BA, CPC, Development Editor I, AAPC