Current Procedural Terminology (CPT) codes have been around since 1966, continue to be set by the specialized panel with the American Medical Association, and they aren’t going anywhere. Each year, as advancements and changes are made in the medical industry, new and revised codes are pushed out to medical billing teams. If you’re already in the world of medical billing and assuming most people reading this are (unless you have stumbled upon this blog unknowingly,) then you are aware of what CPT codes are.
However, there may be a few of you who need a brush-up on what their function is and why they are imperative to understand, as well as those who are new to the business.
Lastly, we will dive into the new and important CPT codes for 2021.
What are CPT codes?
When a patient receives any sort of medical service, whether that is a doctor’s visit, a surgical procedure, or a diagnostic assessment, the medical billing team uses certain five-digit numbers (or codes) to represent those services. In turn, insurers will then use the coded information to determine how much that healthcare provider will be reimbursed for. In the medical world, each 5-digit CPT code means the same thing no matter which city or state the service is in, making the tracking and billing process efficient and uniform.
A few examples of widely-used codes are:
- Anesthesia: 0100 – 01999
- Radiology: 70010 – 79999
- Medicine: 90281 – 99199
- Surgery: 10021 – 69990
Thousands of CPT codes are created and updated annually and, medical billers are responsible for keeping up-to-date on them.
Think of CPT codes as the line of communication between everyone in the healthcare industry, regardless of location and education. Just like there is legal jargon in the world of law and a lot of acronyms in education, each CPT code is known and understood by professionals in the medical field and each stands for something important.
What is the importance of CPT codes?
Imagine being an educator and transferring to a different state. You are used to your current protocols, regulations, and set of terminology, but you aren’t worried. You get to your new place of employment and they begin using acronyms such as EBD, BIP, ADE, FAPE, SARC, ROTC, OHI, ESOL, SLD, STAR, and TBI. This is not good. Everything you have known previously has to be thrown out the window and you have to start over with learning, understanding, and memorizing.
Thankfully, in the real world, there are nationwide, common educational acronyms so that educators can transfer from state to state, communicate across the way, and still make sense of what is going on.
This is also true for professionals working in the realm of medical billing.
Because medicine is such a commonplace field––and it’ll never go out of business––the Current Procedural Terminology codes were created to ensure that there is a uniform language that can be spoken between physicians, insurers, patients, nurses, hospitals, researchers, and other medical staff.
Without CPT codes, conversations between various medical professionals in-house or elsewhere will seem like nonsense. Not only are the use of these codes quite effective and easy to learn, but they have proven to also be highly efficient––which is generally the bottom line.
Qualified healthcare professionals (QHPs) need to identify the professional services they provide and to report those services in a way that can be universally understood by institutions, private and government payers, researchers, and other interested parties (Dotson, 2013).
CPT codes are also crucial in that they allow government agencies to track the number and value of specific medical procedures and services, as well as provide important data surrounding health and mental health.
Overall, just as educators can’t envision themselves without all of their dozens of acronyms, medical professionals, such as medical billers, can’t picture their work-life without those 5-digit codes.
New codes for 2021
Each year the CPT code manual is revised to delete codes and/or guidelines and to add or revise codes to reflect current technologies, techniques, and services. Currently, there are 206 new codes, 69 revised codes, and 54 deleted codes that are important for medical billers to be aware of this year.
The majority of the CPT code additions made in 2021 relate to Proprietary Laboratory Analyses (PLA) codes. These are alpha-numeric CPT codes with a corresponding descriptor for labs or manufacturers that want to more specifically identify their test. Tests with PLA codes must be performed on human specimens and must be requested by the clinical laboratory or the manufacturer that offers the test.
Two code changes that those working in the field of medical billing must be aware of are the vaccine code changes and those related to remote physiologic monitoring.
1. Vaccine code changes
Vaccine code changes are relevant to medical billers and others in the medical field during this time. CPT codes related to vaccines have been created for both the type of vaccine and also the dose of a vaccine. The American Medical Association has a comprehensive list of each code used based on whether someone is getting the Pfizer, Moderna, or another type of vaccine, as well as whether they are getting their first, second, third, or booster dose.
Examples of these include:
- Pfizer Vaccine Code: 91300
- Pfizer First Dose: 0001A
- Pfizer Second Dose 0002A
- Novavax Vaccine Code: 91304
- Novavax First Dose: 0041A
- Novavax Second Dose: 0042A
As you can probably see, once professionals begin using new codes, they become easy to memorize.
2. Remote Physiologic Monitoring
Have you ever had to do a sleep study with monitors hooked up to you? Or what about a week-long study to monitor your vital signs at different times of the day? This is called remote physiologic monitoring––or remote patient monitoring.
Remote Patient Monitoring (RPM) refers to a process of gathering and analysis of patient physiologic data (parameters) used to further establish and implement a treatment plan for chronic and/or acute health illness or condition. It refers to the “periodic, asynchronous, or continuous monitoring and transmission of vital signs such as weight, blood pressure, oxygen saturation, glucose levels, heart rate, or heart rhythm.”
According to Connected Health Technology, there are multiple updates to remote patient monitoring for 2021. These include:
- Twenty minutes includes, but is not limited to, “interactive communication” with the patient
- One physician, per patient, per period, on RPM billing
- Understand the Remote Monitoring Codes: 99091, 99453, 9454, 94557, and 99458, 95250, 99473, and 99474.
- The billing regulations of medicare
- CPT Code 99454 – one patient, two different RPM devices, two different physicians
- Providing RPM services and obtaining consent
- Interactive communication
- The practice expense codes used for RPM
The purpose of these changes is all about providing quality care to patients.
If you have chosen a medical billing career, or any job in the world of medicine, then you more than likely are aware of what CPT codes are and their importance. However, it is always beneficial to get a brushup on new, updated, and relevant CPT codes that walk through the door. There will always be new codes––for as long as the medical field is around and for whatever reason, there will be new and updated Current Procedural Terminology codes. Without them, things will be run inefficiently, there will be miscommunication and mistakes, and medical professional-patient relationships will suffer.
Make sure you stay current with CPT codes through the American Medical Association website or your employer.
If you’re in need of resources to assist with your company’s coding needs, contact 4D Global to inquire about how we can help. 4D can help provide your company with end-to-end revenue cycle management services that will be invaluable and will create success within your business.