Coding and guideline changes 2024

Each new year brings new, revised, and deleted CPT® codes and coding guidelines that become effective Jan. 1.
There are always a lot of changes to learn about: CPT® 2024 includes 230 new codes, 70 revised codes, and 49
deleted codes. There are no code changes for anesthesia, the integumentary system, the digestive system, the male
genital system, or the auditory system. The most significant changes are in the sections for evaluation and
management (E/M) services, the phrenic nerve stimulation system, lab and pathology, COVID-19 and RSV
vaccinations, and Category III codes. Here is an overview of the changes by section.

Evaluation and Management

In the E/M section, code descriptors for office and other outpatient visit codes (99202-99215) were revised to
remove the time ranges to be consistent with other E/M codes. For example, the descriptor for 99213 now reads “…
20 minutes must be met or exceeded.” This editorial change doesn’t change the time associated with each code.

Also in this section, E/M guidelines were added to split/shared visits. CPT® states that the substantive part of the
encounter using medical decision making (MDM):

… requires that the physician(s) or other QHP(s) made or approved the management plan for the number and
complexity of problems addressed at the encounter and takes responsibility for that plan with its inherent risk of
complications and/or morbidity or mortality of patient management. By doing so, a physician or other QHP has
performed two of the three elements used in the selection of the code level based on MDM.

Data is also covered in the guidelines, which is the third element of E/M. If the code selection is based on time, the
provider who spent most of the time would report the service in a split/shared visit.

Guidelines were also added to clarify how to report multiple E/M services on the same date. For example, hospital
inpatient and observation care and nursing facility visits are “per day” services. If the patient is seen multiple times
during the same day in the same setting by a provider of the same specialty and subspecialty in the same group
practice, a single E/M code is reported. A review of the E/M guidelines in detail is needed for proper E/M coding.

Also in this section, two nursing facility codes were revised to change the time for 99306 from 45 minutes to 50
minutes and 99308 from 15 minutes to 20 minutes.

Surgery: Musculoskeletal System

CPT® 2024 adds three new codes for anterior thoracic vertebral body tethering. This technique is an alternative to
traditional spinal fusion surgery, which involves fusing together the vertebrae to stabilize the spine, eliminating
motion in the fused segments. Anterior vertebral body tethering is considered a less invasive option that allows for
continued spinal growth and movement. This procedure is performed on patients with scoliosis. Introductory
guidelines and parenthetical guidance are also added for the following codes:

• 22836 is for anterior thoracic vertebral body tethering when performed for up to seven vertebral
segments.
 • 22837 is for anterior thoracic vertebral body tethering when performed for eight or more vertebral
segments.

• 22838 is for the revision, replacement, or removal of the thoracic vertebral body tethering.

A new code for sacroiliac joint arthrodesis, 27278, was added to report the placement of an intra-articular
stabilization device using a minimally invasive technique that does not transfix the joint.

Codes in the correction of the hallux valgus family (28292-28299) were revised to remove bunionectomy from
parentheses and clarify that the procedure is “with bunionectomy.”

Surgery: Respiratory System

Two new codes were created for the destruction of the posterior nasal nerve during a nasal/sinus endoscopy. Code
31242 was added to report the procedure performed using radiofrequency ablation. Code 31243 was added to
report the procedure performed using cryoablation.

Surgery: Cardiovascular System

CPT® 2024 includes eight new codes for the phrenic nerve stimulation system. Introductory guidelines and
parentheticals are also added. The new codes are:

• 33276 is for the insertion of the pulse generator and stimulating leads and generator initial analysis with
diagnostic mode activation.

• +33277 is an add-on code for the insertion of transvenous sensing lead.

• 33278 is for the removal of the pulse generator and lead(s).

• 33279 is for the removal of only the leads.

• 33280 is for the removal of only the pacemaker.

• 33281 is for the repositioning of the lead(s).

• 33287 is for the removal and replacement of the pulse generator.

• 33288 is for the removal and replacement of the lead(s).

Surgery: Urinary System

New code 52284 describes cystourethroscopy with mechanical urethral dilation and urethral therapeutic drug
delivery using a drug-coated balloon catheter for urethral stricture or stenosis in a male patient. The procedure
includes fluoroscopy.

Surgery: Female Genital System

Transcervical radiofrequency ablation of uterine fibroid(s) is described by new code 58580. The procedure includes
intraoperative ultrasound guidance and monitoring.
 Surgery: Nervous System
Three new codes were created for skull-mounted cranial pulse generator or receiver procedures. The insertion is
reported with 61889; revision or replacement is reported with 61891; and the removal is reported with 61892.

Insertion or replacement of a spinal neurostimulator pulse generator or receiver code 63685 was revised to require
pocket creation and connection between the array and the pulse generator or receiver.

Revision or removal of the implanted spinal neurostimulator code 63688 was revised to include “with detachable
connection to electrode array.”

Code 64590 was revised to include “sacral” and to specify that the procedure requires pocket creation and
connection between the electrode array and pulse generator or receiver. Code 64595 was revised to include
“sacral” and to specify that the procedure is with a detachable connection to the electrode array.

New code 64596 describes the insertion or replacement of the initial electrode array for the percutaneous electrode
array of a peripheral nerve with an integrated neurostimulator. New add-on code +64597 is used with 94596 for
each additional electrode array. New code 64598 describes the revision or removal of the neurostimulator electrode
array with integrated neurostimulator of a peripheral nerve.

Surgery: Eye and Ocular Adnexa

New code 67516 describes the injection of a pharmacologic agent in the suprachoroidal space. The medication is
reported separately.

Radiology
The code for pelvimetry, 74710, was deleted. New code 75580 was added to describe a noninvasive estimate of
coronary fractional flow reserve (FFR) derived from augmentative software analysis of the data set from a coronary
computed tomography angiography. A diagnostic intraoperative thoracic aorta ultrasound is described by new
code 76984.

Three new codes were added for epicardial ultrasound for congenital heart disease. When all components are
performed, including the placement and manipulation of the transducer, image acquisition, interpretation, and
report, use new code 76987. When the provider only performs the placement, manipulation of the transducer, and
image acquisition, use new code 76988. When the provider performs only the interpretation and report, use 76989.

Pathology and Laboratory

Codes 81171, 81172, 81243, 81244, 81403, 81404, 81405, 81406, and 81407 were revised to replace “mental
retardation” with “intellectual disability.”

Also in this section, you’ll find six new genomic sequence analysis panel codes for solid organ neoplasms:

• 81457 is for interrogation for sequence variants; DNA analysis, microsatellite instability.
 • 81458 is for interrogation for sequence variants; DNA analysis, copy number variants, and microsatellite
instability.

• 81459 is for interrogation for sequence variants; DNA analysis or combined DNA and RNA analysis, copy
number variants, microsatellite instability, tumor mutation burden, and rearrangements.

• 81462 is for cell-free nucleic acid (e.g., plasma) interrogation for sequence variants; DNA analysis or
combined DNA and RNA analysis, copy number variants, and rearrangements.

• 81463 is for cell-free nucleic acid (e.g., plasma) interrogation for sequence variants; DNA analysis, copy
number variants, and microsatellite instability.

• 81464 is for cell-free nucleic acid (e.g., plasma) interrogation for sequence variants; DNA analysis or
combined DNA and RNA analysis, copy number variants, microsatellite instability, tumor mutation burden, and
rearrangements.

New multianalyte assays with algorithmic analyses (MAAA) code 81517 was added for liver fibrosis and liver-
related clinical events within five years.

New code 82166 describes the chemistry test for anti-mullerian hormone (AMH).

Three new immunology codes were created for acetylcholine receptors (AChR): 86041 describes when the
procedure includes the binding antibody; 86042 describes when the procedure includes the blocking antibody; and
86043 describes when the procedure includes the modulating antibody.

New code 86366 describes testing for muscle-specific kinase (MuSK) antibodies. New code 87523 was added for
hepatitis D. New code 87593 describes orthopoxvirus (e.g., monkeypox virus, cowpox virus, vaccinia virus) testing.

There are also many new proprietary laboratory analyses (PLA) codes. These codes describe PLAs provided by either
a single laboratory or licensed/marketed to multiple providing laboratories. This subsection includes MAAA and
genomic sequencing procedures (GSP).

Medicine
Two new codes were created for respiratory syncytial virus (RSV) in the immune globulins subsection of the
medicine section for the monoclonal antibody, seasonal dose. The code is selected based on dose: 90380 describes
a 0.5 mL dose and 90381 describes a 1 mL dose.

There have been many changes to the COVID-19 vaccine codes that are not included in the CPT® 2024 code book
because the changes were made after the code book was printed.

A new vaccination administration code, 90480, was approved for reporting the administration of any COVID-19
vaccine for any patient (pediatric or adult), replacing all previously approved specific vaccine administration codes.
The new administration code includes counseling.

There are three new Pfizer vaccine product codes: 91318 is for patients who are 6 months through 4 years; 91319 is
for patients who are 5 years through 11 years; and 91320 is for patients who are 12 years and older.
There are two new Moderna vaccine product codes: 91321 is for patients who are 6 months through 11 years and
91322 is for patients who are 12 years and older.

The new codes went into effect Sept. 11, 2023. All previously approved COVID-19 vaccine supply and administration
codes will be deleted from the CPT® code set effective Nov. 1, 2023. All the changes can be found on the AMA
website and in the AAPC blog. The changes are also covered in CPT® Assistant Erratum for Special Edition: August
Update, also available on the AMA website.

There are two new vaccine supply codes for RSV. Code 90679 describes reF, subunit, and bivalent, for intramuscular
use. Code 90683 describes preF, recombinant, subunit, and adjuvanted, for intramuscular use.

Four new codes were created for the phrenic nerve stimulation system. New code 93150 describes therapy
activation. Interrogation and programming are described with 93151. When interrogation and programming are
performed during polysomnography, report 93152. When only interrogation is performed without programming,
report 93153.

Five new add-on codes were created for venography for congenital heart defects. All the procedures include
catheter placement and radiological supervision and interpretation. New guidelines and parentheticals have also
been added:

• +93584 is for the anomalous or persistent superior vena cava when it exists as a second
contralateral superior vena cava, with native drainage to heart.

• +93585 is for the azygos/hemiazygos venous system.

• +93586 is for the coronary sinus.

• +93587 is for venovenous collaterals originating at or above the heart.

• +93588 is for venovenous collaterals originating below the heart.

Three new codes (97550-97552) were created for caregiver training.

Category III Codes

There are many new Category III codes created for new and emerging technology. Some examples include new add-
on codes +0827T-+0856T for digital pathology digitization procedures, 0795T-0804T for dual-chamber leadless
pacemaker, and 0820T, +0821T, and +0822T for continuous monitoring and intervention during psychedelic
medication therapy.