Key CPT and Medicare Changes for Family Medicine in 2022

 

The 2022 updates don't include massive E/M coding changes like last year, but several changes are much-needed and relevant to family physicians.

Fam Pract Manag. 2022 Jan-Feb;29(1):9-14.

Author disclosures: no relevant financial relationships.

Once again, the start of a new year brings changes to CPT coding, Medicare payment policy, and Medicare's Quality Payment Program (QPP). Some of this year's changes are much-needed, which will hopefully lessen the pain of adjusting to them. Here's what's most relevant to family physicians.

KEY POINTS

  • CPT clarified aspects of last year's E/M coding changes, including the definition of a “unique” test, what “discussion” between physicians and patients means, and the difference between major and minor surgery.

  • There are several telehealth-related changes this year, including a Medicare provision for ongoing coverage of audio-only mental health services under certain conditions.

  • The Centers for Medicare & Medicaid Services has increased the rates it pays for chronic care management and for administering several vaccines.

CPT CHANGES

There are several noteworthy CPT changes this year, including some related to evaluation and management (E/M).

Office and other outpatient E/M services. Last year CPT made substantial changes to new and established patient E/M codes (99202-99215).1 This year CPT clarified several aspects of those changes, including the following:2

  • Specifying which activities do not count when time is used to determine the level of service: travel, teaching that is general and not limited to management of that specific patient, and time spent on other, separately reported services.

  • Clarifying when to report a test that is considered but not selected after shared decision making: A test that is considered but not performed counts as long as the consideration is documented. For example, the physician may explain to the patient that a diagnostic test the patient requested would have little benefit.

  • Defining “analyzed” for reporting tests in the data column: “Analyzed” means using data as part of the medical decision making process. Tests that do not require an analysis still count if they are a factor in diagnosis, evaluation, or treatment.

  • Clarifying the definition of a “unique” test: Multiple results of the same tests during an E/M service are considered one unique test. Tests with overlapping elements are not considered unique even if they have distinct CPT codes.

  • Clarifying what is meant by “discussion” between physicians/other qualified health care professionals (QHPs) and patients: “Discussion” requires a direct, interactive exchange. Sending notes does not count.

  • Clarifying who decides the difference between major and minor surgery: The classification of major and minor surgery is determined by the meaning of those terms when used by a trained clinician. It is not determined by payers' classifications of surgical packages.

Principal care management services. CPT added a new category of principal care

ABOUT THE AUTHORS

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Kent Moore is senior strategist for physician payment...

Emily Hill is president of Hill & Associates, a Wilmington, N.C., consulting firm specializing in coding and compliance.

Erin Solis is manager of practice and payment at the American Academy of Family Physicians.

Author disclosures: no relevant financial relationships.

References

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1. Millette KW. Countdown to the E/M coding changes. Fam Pract Manag. 2020;27(5):29–36....

2. CPT 2022 Professional Edition. American Medical Association; 2021.

3. COVID-19 vaccines coding guide. FPM Getting Paid blog. Jan. 6, 2021. Accessed Dec. 2, 2021. https://www.aafp.org/

4. CPT Appendix Q: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) Vaccines. American Medical Association. Accessed Dec. 2, 2021. https://www.ama-assn.org/

5. CMS releases 2022 MIPS final rule – key takeaways. MDinteractive. Nov. 5, 2021. Accessed Dec. 3, 2021. https://mdinteractive.com/

6. Solis E. CMS to automatically apply ‘extreme and uncontrollable circumstances’ policy to some MIPS participants. FPM Getting Paid blog. Nov. 10, 2021. Accessed Dec. 3, 2021. https://www.aafp.org/

 
 

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