You may be accustomed to adapting to new technologies and updated electronic health record (EHR) requirements in the new year, but one thing you won’t want to overlook when the calendar turns to 2023 is to learn the updated Current Procedural Terminology (CPT) codes. Often, these codes are downloaded to your EHR, but if you aren’t aware of what’s new, you may opt for a less accurate choice.
The American Medical Association released the 2023 CPT code set on Sept. 9, which covers 393 changes to the procedure codes. About 225 of those reflect brand-new codes, while 75 codes were deleted and 93 codes were revised.
“It can be tempting to ignore new codes when they’re released and leave them to the back office staff, but oncologists really need to get a feel for new CPT codes as well,” said Julie Belle, CPC, a medical coder based in Garner, North Carolina. “If you don’t know the differences between the codes, you may not document thoroughly enough for the coder to select the right procedure code, and this could cause you to submit incorrect codes. This may mean you don’t collect the right amount, or could even lead to fraud accusations,” she added.
Take a look at some of the coding changes that will be most relevant to oncologists when they go into effect on Jan. 1, 2023.
First, CPT adds a new code for laparoscopic prostatectomy that joins the existing surgical codes addressing the prostate.
When a physician uses robotic assistance to remove the prostate, use 55867 (Laparoscopy, surgical prostatectomy, simple subtotal (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy), includes robotic assistance, when performed).
You’ll also find several new lab codes that reflect tests performed on patients with cancer or those who are being tested for cancerous conditions:
81441 (Inherited bone marrow failure syndromes (IBMFS) (eg, Fanconi anemia, dyskeratosis congenita, Diamond-Blackfan anemia, Shwachman-Diamond syndrome, GATA2 deficiency syndrome, congenital amegakaryocytic thrombocytopenia) sequence analysis panel, must include sequencing of at least 30 genes, including BRCA2, BRIP1, DKC1, FANCA, FANCB, FANCC, FANCD2, FANCE, FANCF, FANCG, FANCI, FANCL, GATA1, GATA2, MPL, NHP2, NOP10, PALB2, RAD51C, RPL11, RPL35A, RPL5, RPS10, RPS19, RPS24, RPS26, RPS7, SBDS, TERT, and TINF2)
81449 (Targeted genomic sequence analysis panel, solid organ neoplasm, 5-50 genes (eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, MET, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed; RNA analysis)
81451 (Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, 5-50 genes (eg, BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NOTCH1, NPM1, NRAS), interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis)
81456 (Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes (eg, ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MET, MLL, NOTCH1, NPM1, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis)
Oncologists will also note that CPT 2023 includes a Category III code, 0739T (Ablation of malignant prostate tissue by magnetic field induction, including all intraprocedural, transperineal needle/catheter placement for nanoparticle installation and intraprocedural temperature monitoring, thermal dosimetry, bladder irrigation, and magnetic field nanoparticle activation). If you ablate malignant prostate tissue using magnetic field induction, you should report this code after Jan. 1.
Remember, category III codes reflect emerging technologies, procedures, services, etc. The more you report this code, the more data on its use will be collected. This code has no assigned Relative Value Unit (RVU) or established payment, meaning the reimbursement is at the payer’s discretion. Be sure to include the operative report, letter of medical necessity, and copy of the U.S. Food and Drug Administration approval letter to help support your claim.