It’s time to implement the annual updates to the CPT codes. The code development process goes on for most of the year, and these were finalized and released in September. This allows time for electronic systems to incorporate them, since the changes take effect on January 1 of each New Year and 2022 has quite a few.
In total there are 249 new codes, 63 deletions and 93 revisions. Your medical billing software should already have the coding modifications ready to go, but it is still important for medical professionals and billing staff to know what they are since there are often input changes required to make sure the correct codes are applied.
COVID-19 Vaccination Gained Additional Codes
The SARS-CoV-2 coronavirus continues to be a major focal point for new coding. The code set for 2022 includes a series of 15 codes that relate specifically to vaccines. These codes are designed not only to assign reimbursement for services and the vaccines themselves but also to provide a way to report and track immunizations.
The American Medical Association (AMA) manages the codes, but in this case, collaborated with the Centers for Disease Control and Prevention (CDC) to develop vaccine coding to document which vaccine was administered and support scheduling, reporting, tracking and analysis of vaccinations.
For the full list of vaccine codes, medical billing staff can refer to AMA’s Guidance, “Find your COVID-19 Vaccine CPT Codes,” which includes vaccine and administration codes for Pfizer, Moderna, AstraZenica, Janssen and Novavax.
Tracking and analyzing vaccination in the American population is facilitated by unique codes for each vaccine’s first, second, third and booster doses.
Coding for COVID-19 Vaccines Is Detailed
Even though a booster is commonly a third dose of a vaccine, there are different requirements for the availability and timing of each administration, so it is important to document which is being given. This is a good illustration of how coding is used for reporting and tracking.
For example, the primary administration for Pfizer’s vaccine is two doses, to be given 21 days apart. But immunocompromised individuals should receive an “additional dose” (third dose) at least 28 days later.
When it was determined that the benefits of the COVID-19 mRNA vaccines fade over time, “booster” doses were authorized for adults. The booster is to be given at least six months after the last dose of the vaccine was given, so it may be a third or fourth dose, depending on whether the person received an additional dose in their original series.
Regardless of whether it is the third or fourth dose, the booster six or more months later is coded with the appropriate vaccine code and the administration code for a booster, which varies depending on the vaccine.
Another important detail to be aware of is that there are several different vaccine codes for Pfizer. 91300 notes the original formulation and 91305 is for the newer formulation with a tris-sucrose buffer. 91307 is used for the pediatric dose, which has been approved for children ages 5 through 11. And again, distinct additional codes are used to indicate which dose was given.
2022 Modifications for Digital Medicine
The COVID-19 pandemic created an urgent need to expand digital medicine, allowing people to see physicians without potentially being exposed to the virus—or spreading it to health care staff. Virtual access to medical help has many benefits beyond the pandemic and usage continues to increase.
New codes and clarifications are being developed to cover this new venue for service provision, but what is and is not allowed can be confusing. The 2022 CPT code set includes new codes and an appendix that provides AMA’s taxonomy to clarify the categories digital medicine services.
CPT Code Changes in Many Areas
In addition to the codes relating to COVID-19 and digital medicine, there are modifications for many different specializations. When the new code set was released in September, AMA said 43% of the changes were “tied to new technology services described in Category III CPT Codes and the continued expansion of the Proprietary Laboratory Analyses (PLA) section.”
The annual editorial process is intended to make sure the coding system keeps up with the modern health care system, which AMA specifies to include digital health, precision medicine and augmented intelligence. This year’s changes also included principal care management for patients with a complex chronic condition and quite a few different types of surgeries.
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