On January 1 of each year, the American Medical Association publishes a new set of CPT codes. Podiatrists see changes, additions, and deletions annually.
Here are the podiatrist-relevant cpt changes. CPT is owned by the AMA and shared for education.
This podiatry-specific resource codes quickly and accurately despite hundreds of CPT 2023 code changes.
Coders Specialty Guide 2023 podiatry’s one-code, one-page layout organizes everything you need for each CPT code on a single page for quick reference—lay terms, code crosswalks, CCI edits, anatomical illustrations, RVUs, Medicare reimbursement details, and expert coding tips. HCPCS and BETOS codes, too!
Management and Assessment
E&M level selection is the biggest change for 2023. Podiatry Management covered this extensively in November/December 2022.
On January 1, 2023, the office or another outpatient, hospital inpatient, observation care, consultation, emergency department, nursing facility, and home or residence E&M services were deleted. CPT 99224–99226 is gone.
With this change, the Hospital Inpatient E&M codes (CPT 99221–99223 and 99231-99233) will be renamed “Hospital Inpatient or Observation Care E&M.”
The same E&M codes will be used for observation and inpatient hospital admissions.
The CPT codes for providing care in a domiciliary setting, a rest home, or a custodial setting were eliminated on January 1, 2023. CPT 99324-99328 and 99334-99337 will disappear.
Patients seen in any of the following settings will have the following core set applied to them:
- Domiciliary
- Rest home
- Custodial care
- Home
The following CPT codes will no longer be valid as of the 1st of January, 2023:
CPT 99241 is an office consultation for a new or established patient that must include all three of the following essential components: a problem-focused history, a problem-focused examination, and simple medical decision-making.
Initial inpatient consultation for a new or established patient, requires three key components: a problem-focused history, a problem-focused examination, and straightforward medical decision-making. CPT 99251 is the code for this type of consultation.
CPT 99318 is the evaluation and management of a patient that involves an annual nursing facility assessment.
This evaluation and management must include the following three essential components: a detailed interval history; a comprehensive examination; and medical decision-making that ranges from low to moderate complexity.
The following are examples of common podiatric procedures that may involve the use of sutures or staples and have zero-day global periods:
- Amputation of the toe at the metatarsophalangeal joint is covered by CPT code 28820.
- Amputation of the toe at the interphalangeal joint (CPT 28825)
COVID-19 Vaccine
COVID-19 vaccinations, including boosters, are represented by many new CPT codes.
COVID-19 vaccine providers should consult the 2023 CPT code set to ensure they use the right code for the vaccine type and dose.
If the only service provided at an encounter is a vaccination, a CPT code for E&M is inappropriate.
Suture/Staple Removal
There are now two new CPT codes that represent the removal of sutures or staples: CPT 15853 — Non-anesthetic removal of sutures or staples (List separately in addition to E/M code)
CPT 28001—Incision and drainage of a bursa on foot:
CPT 28002—Incision and drainage below fascia, with or without tendon sheath involvement, foot; single bursal space
CPT 28003—Incision and drainage below fascia, with or without CPT 15854—Removal of sutures and staples not requiring anesthesia (List separately in addition to E/M code) CPT 28003—Incision and drainage below fascia CPT 15854—Removal of sutures and staples not requiring anesthesia
These CPT codes can be used if the patient is not in a global period for the provider who removes the sutures/staples.
In order to submit these codes, a medically necessary E&M must be performed and documented as these two new codes can only be submitted as an add-on code to one of the following E&M services:
CPT
| 99202 | 99203 | 99204 | 99205 | 99211 |
| 99212 | 99213 | 99214 | 99215 | 99281 |
| 99282 | 99283 | 99284 | 99285 | 99341 |
| 99342 | 99344 | 99345 | 99347 | 99348 |
| 99349 | 99350 |
Because these are add-on codes, the E&M submitted for the same encounter does not need to be significantly and separately identifiable from the suture/staple removal.
New Ultrasound Code CPT
76883 — Ultrasound of nerve(s) and surrounding structures along their entire anatomic course in one extremity, including real-time cine imaging with image documentation per extremity.
This CPT code represents imaging of a nerve’s entire course, rather than just a section or area of inflammation. This CPT code’s proper use is clarified by CPT:
A nerve’s entire course in an extremity is evaluated in a comprehensive nerve evaluation. To demonstrate anatomy, cine clips and static images of a nerve’s entire course through an extremity are acquired and archived.
Effective January 1, 2021, the American Medical Association (AMA) CPT® Editorial Panel changed the selection process for office and other outpatient evaluation and management (E&M) levels (CPT® 99202–99215).
This welcome change removed barriers to higher office and other outpatient E&M levels for some specialists.
The method used to select the level of these E&M service types will also be changed on January 1, 2023, under the guidance of the AMA CPT Editorial Panel:
- Hospital Inpatient and Observation Care
- Consultation
- Emergency Department
- Nursing Facility
- Home or Residence
This change allows one to choose an office or another outpatient, hospital inpatient, and observation care, consultation, emergency department, nursing facility, and home or residence E&M services based on medical decision-making or total time.
Medical Decision-Making Effective January 1, 2023, 2 Medical decision-making levels are:
- Simple Medical Decisions
- Low Medical Decision-Making
- Medical Decision
- Making Moderate High
Three medical decision-making factors determine the E&M level:
- Number and complexity of problems addressed Data to be reviewed and analyzed
- Patient Management Complications and Mortality.
- Each E&M type will have its own thresholds of those three medical decision-making elements starting January 1, 2023. If the encounter was medically necessary, performed, and documented, that E&M level may be selected.
Conclusion
The 2023 CPT code set contains several podiatrist-related changes. CPT code submitters should know the code set or use outside experts. For services provided after January 1, 2023, all providers should use the 2023 CPT code set.
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