December 13, 2024 | By Rhonda Granja, B.S., CMA, CPC, RMC, CMC, CMOM, CMIS
As we navigate this complex world of coding, every year we prepare for changes, updates, new codes as well as deletion of codes. For 2025, there are 420 overall updates that are in the CPT 2025 code set. Those include 270 new codes, 112 deletions, and 38 revisions. Interesting to note that the biggest impact is around areas of laboratory analyses and also with Category III codes which are all about emerging technology services. Medicine continues to advance.
There are some editorial revisions that have been made to (RTM) remote therapeutic monitoring services. CPT codes 98976-98978 have been revised to include device supply.
Of note, it is essential that practices be aware of the changes that are happening within the telehealth arena of healthcare. Be mindful that audio-only telephone services, being CPT codes 99441-99443 are deleted. There are 17 new telehealth codes that are added for 2025. Those being 98000-98016. It is critical that we keep in mind restrictions that were in place prior to the pandemic are being reinstated.
How does this affect most clinics? It essentially means that unless we have a Medicare patient that lives in a HPSA (health professional shortage area) or a rural area, they will not be covered for telehealth services.
Just when we think that we have all of this figured out, changes occur and cause issues. We are hopeful that Congress will act here as we have heard the benefits that come from providing telehealth services. Our new code set will differentiate between new and established patients as well as including time as a factor if basing the level of service based on total time versus medical decision making.
The brief communication technology code of 98016 will be utilized for patient portal discussions and interesting to note that HCPCS code G2012 is being deleted. This service has to be patient initiated.
One interesting thing that I have read in the proposed rule has to do with the complexity code of G2211. This code became effective on 1-01-2024 but the implementation date was not until 2-19-2024. We may be able to bill this in certain situations with modifier 25 of which we are prohibited from doing right now. Current information can be found by referencing (MM13473 – How to Use the Office and Outpatient Evaluation and Management Visit Complexity Add-on Code G2211). My rationale for mentioning this code is that I still have providers that do not know that this code exists and we have been spreading the word for about 11 months. We will await the Final Rule date of 12-09-2024 to get clear direction on this code in which some practices have implemented and others may have missed revenue opportunities.
Updates have also taken place within the general surgery section of the CPT book. These primarily involve skin grafts with regard to wound care and codes 15011-15018.
Our suggestion is to become aware of the codes that your practice uses routinely and stay abreast of the changes that may directly involve your patients and that can affect your revenue. Be sure to order materials in advance so that you can familiarize yourself with the changes.
Every year when my book arrives, the very first thing that I do is to turn to Appendix B as it outlines all of the new, revised, and deleted codes. I can then make notations for my providers to educate them as well as coders so that we have the latest and greatest information at our disposal. Keep in mind that it some times takes a while for the payors to get on-board with changes. We sometimes have to educate them as well.
While we refer to guidelines and published coding rules and regulations, it is also necessary to check with your contracted payors for specific rules that may be applicable for them. Coders/billers need to be sure to rely on credible resources for their up-to-date information. That is one of the things that I look to NAMAS for. You can be sure that due diligence has been done to share information with the community of coders, billers, and auditors so that we in turn can be an extension of our providers.
My opinion is that a patient’s financial health is just as important as their physical health. I like to think that my small part in that journey makes a difference. For that reason, we need to embrace for the new things to come in 2025!
