CPT 2024 E&M code changes
CPT 2024 removes the time ranges from both the new and established office/outpatient E/M codes and replace them with a single total time amount, which is the lowest number of minutes in the current range for each code. This time “must be met or exceeded” according to the new wording that now appears in each of the codes’ descriptors.
In table form, the changes look like this:
| CODE | 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” |
|---|---|---|
| 99202 | 15-29 | 15 |
| 99203 | 30-44 | 30 |
| 99204 | 45-59 | 45 |
| 99205 | 60-74 | 60 |
| 99212 | 10-19 | 10 |
| 99213 | 20-29 | 20 |
| 99214 | 30-39 | 30 |
| 99215 | 40-54 | 40 |
No change on 99211 CPT Code
CPT is not 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. You will continue to bill this code per usual in 2024.
G2211
New add on code G2211 which is effective from 2024 to capture reimbursement for complex Medicare patient visits
G2211 – Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established)
Consider This
Before you begin to bill for this service, however, there are a few things to consider:
- Providers billing the add-on code are expected to provide longitudinal care to the patient.
- Providers who do not intend to have an ongoing longitudinal relationship with the patient (e.g., urgent care, consultants, second opinions, etc.) should not bill G2211.
- Primary care physicians and specialists may bill this add-on code.
- Bill G2211 in conjunction with an office or other outpatient evaluation and management (E/M) service.
- Add-on code G2211 may be billed with telehealth services.
- Do not bill G2211 when the E/M service is reported with modifier 25 for a procedure rendered by the same provider.
- Do not bill G2211 when chronic/complex conditions are documented but not considered or addressed in the E/M of the patient.
2024 adds new CPT code + 99459 for Pelvic examination
It is a practice expense (PE) only code, as the physician or other qualified healthcare provider (QHP) work is captured in the evaluation and management service. Reimbursement for CPT 99459 is to capture the clinical staff time for chaperoning the procedure, as well as additional supplies, such as the speculum.
Use 99459 in conjunction with 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242, 99243, 99244, 99245, 99383, 99384, 99385, 99386, 99387, 99393, 99394, 99395, 99396, 99397
Telehealth
Permanent Medicare changes
- Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can serve as a distant site provider for behavioral/mental telehealth services
- Medicare patients can receive telehealth services for behavioral/mental health care in their home
- There are no geographic restrictions for originating site for behavioral/mental telehealth services
- Behavioral/mental telehealth services can be delivered using audio-only communication platforms
- Rural Emergency Hospitals (REHs) are eligible originating sites for telehealth
Temporary Medicare changes through December 31, 2024
- FQHCs and RHCs can serve as a distant site provider for non-behavioral/mental telehealth services
- Medicare patients can receive telehealth services in their home
- There are no geographic restrictions for originating site for non-behavioral/mental telehealth services
- Some non-behavioral/mental telehealth services can be delivered using audio-only communication platforms
- An in-person visit within six months of an initial behavioral /mental telehealth service, and annually thereafter, is not required
- Telehealth services can be provided by all eligible Medicare provider
Starting January 1, 2024, use:
- P OS 02: Telehealth Provided Other than in Patient’s Home Descriptor: The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology.
- POS 10: Telehealth Provided in Patient’s Home Descriptor: The location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.
- Starting January 1, 2024, medicare pays for telehealth services you provide to patients in their homes at the non-facility PFS rate
HCPCS Code
2024 HCPS Code changes
Effective April 1, 2024 there is a new single HCPCS J code for DepoMedrol (methylprednisolone acetate): J1010 (Injection, methylprednisolone acetate, 1mg).
This was previously reported with 3 HCPCS codes:
J1020 (Injection, methylprednisolone acetate, 20mg)
J1030 (Injection, methylprednisolone acetate, 40mg)
J1040 (Injection, methylprednisolone acetate, 80mg)
J1010 now represents “1mg”, so each milligram reported will be as a unit. If the provider injects DepoMedrol 80mg, this will be reported as J1010 x 80 units.
streamlined insurance claims, and ultimately, seamless patient care.
ICD-10
2024 ICD 10 Coding changes
For the fiscal year 2024 changes to ICD-10 CM code includes 395 new codes, the deletion of 25 existing codes, and the revision of 22 codes.
Few changes include
Chapter 20 – External Causes of Morbidity (V00-Y99) has the biggest remodel in this year’s codes with 123 updates, almost half of this year’s new codes. The expansion in this chapter pertains to foreign bodies, including batteries, plastic objects, glass items, metal objects (magnetic and non-magnetic), organic and non-organic items, and sharp objects entering into or through a natural orifice.
Some examples include:
W44.B3xAPlastic toy and toy part entering into or through a natural orifice, initial encounter
W44.H0xAOther sharp object unspecified, entering into or through a natural orifice, initial encounter
W44.F3xAFood entering into or through a natural orifice, initial encounter
W44.A1XAButton battery entering into or through a natural orifice, initial encounter
W44.C0XAGlass unspecified, entering into or through a natural orifice, initial encounter
W44.H2XDKnife, sword or dagger entering into or through a natural orifice, subsequent
Chapter 13 – Diseases of the musculoskeletal system and connective tissue (M00-M99), has 42 new codes to help further define osteoporosis with pathological fracture.
For instance:
M80.8B2POther osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with malunion
M80.8B9DOther osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with routine healing
M80.0B1KAge-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with nonunion
M80.0B2GAge-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with delayed healing
Chapter 7 – Diseases of the Eye and Adnexa (H00-H59), has 34 additions and one deletion. The new codes include non-proliferative/proliferative sickle-cell retinopathy, other strabismus to include specific eye muscle entrapment, and foreign body sensation. The changes also include laterality.
Chapter 21 – Factors Influencing Health Status and Contact with Health Services (Z00-Z99), has 30 additions and six deletions. The deletions are due to expanded diagnosis codes. The new codes include observation of newborn for suspected condition ruled out, carrier of Acinetobacter baumannii bacteria, encounter for prophylactic measures, family history of specific colon polyps and caregiver’s non-compliance type. Social Determinants of Health (SDoH) have also been enhanced, with new codes for child custody and parental/adult-child conflict.
Other notable FY 2024 final ICD-10-CM code updates include:
- 24 new codes added to Chapter 6 – Diseases of the nervous system (G00-G99)
- 34 new codes added to Chapter 7, Diseases of the eye and adnexa (H00-H59)
- 22 new codes added and six revised in Chapter 17 – Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
