2021 CPT coding changes affect payment for E/M and other services

Numerous changes in American Medical Association (AMA) Current Procedural Terminology (CPT)* coding will be implemented in 2021. This article describes coding changes that are relevant to general surgery and its related specialties.

Office and other outpatient E/M services

For the first time in nearly 30 years, the office and other outpatient evaluation and management (E/M) CPT code set (99202–99205, 99211–99215) has been extensively revised, including the deletion of code 99201 and the addition of a new code, 99417, for reporting incremental additional time associated with prolonged office or other outpatient services on the day of encounter. Table 1 highlights the changes to the office and other outpatient E/M code descriptors for 2021. Along with the changes to this code set, new and revised CPT guidelines and definitions have been published. To assist with understanding all of the changes in reporting this set of services, the American College of Surgeons (ACS) has developed resource pages, which can be accessed via this web page: facs.org/emcoding.

Appendix C: Clinical examples

Clinical examples for E/M codes are included in Appendix C of the CPT codebook, providing context for the descriptors and assisting practices in the selection of the correct level of code. Each example was developed by surgical and medical specialties as indicated. Because of the extensive changes in reporting office and other outpatient E/M services, the AMA CPT Editorial Panel removed all examples related to codes 99201–99215.

Staging laparotomy

The AMA CPT Editorial Panel annually screens the code set for codes that are rarely reported. Code 49220, Staging laparotomy for Hodgkin’s disease or lymphoma (includes splenectomy, needle or open biopsies of both liver lobes, possibly also removal of abdominal nodes, abdominal node and/or bone marrow biopsies, ovarian repositioning), was identified through this screen. The ACS did not disagree with the CPT Editorial Panel request to delete this code because the work related to treating patients with Hodgkin’s disease or lymphoma will be variable. The ACS recommends that specific staging procedures should be reported when performed.

Irreversible electroporation

New codes 0600T, Ablation, irreversible electroporation; 1 or more tumors per organ, including imaging guidance, when performed, percutaneous, and 0601T, Ablation, irreversible electroporation; 1 or more tumors per organ, including imaging guidance, when performed, open, have been established to report irreversible electroporation (IRE) of organ tumor(s). IRE is a new technology used in cancer treatment. Similar to chemotherapy, IRE destroys cancer cells, but rather than using drugs IRE uses electrical impulses that create permanent small pores, called nanopores, in the cell membrane. Both new codes include imaging guidance, when performed, that is not separately reportable. CPT Category III codes do not have assigned relative value units (RVUs), and eligibility for payment, as well as coverage policy, is determined by each individual third-party payor. For specific details about payment for these procedures, physicians should contact their local third-party payors because reimbursement varies.

Breast repair and/or reconstruction

Extensive changes have been made to the Breast Repair and/or Reconstruction subsection of the CPT codebook. The code descriptors have been updated to reflect current standards of practice and terminology and new introductory guidelines provide definitions and guidance on correct reporting. Table 2 provides the revised code descriptors for 2021.

ACS Coding Hotline

As part of the ACS’ ongoing efforts to support Fellows and their practices to submit clean claims and receive proper reimbursement, a coding consultation service—the ACS Coding Hotline—has been established that Fellows and their practice staff may contact with questions related to CPT, Healthcare Common Procedure Coding System, and International Classification of Diseases-10 coding, as well as other billing-related issues. ACS Fellows are offered five free consultation units (CUs) per calendar year. One CU is a period of up to 10 minutes of coding services time.

How to get help

  1. Access the ACS Coding Hotline website at www.prsnetwork.com/acshotline.
  2. Fill out the specified contact information, including your ACS membership number. Note that practice staff may submit questions to the Coding Hotline on behalf of an ACS Fellow by using the Fellow’s membership number.
  3. Describe your question(s) in the text box, attach any supporting Health Insurance Portability and Accountability Act-compliant documentation (for example, de-identified operative notes or claims denials), and submit.
  4. A member of the Coding Hotline staff will reach out to you via e-mail to answer your question(s).

*All specific references to CPT codes and descriptions are © 2020 Ameri-can Medical Association. All rights reserved. CPT is a registered trade-mark of the American Medical Association.

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