Every year, there are changes made to both the Current Procedural Terminology (CPT) procedure codes and the International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes.
The Centers for Medicare and Medicaid Services (CMS) also institutes changes for billing for services to Medicare and Medicaid patients. The ICD changes took effect on October 1, 2023, and the CPT and CMS program changes will take effect on January 1, 2024.
Let’s review the changes that healthcare providers should be on the lookout for in 2024.
Understanding the annual changes
CMS annually establishes a value for the services covered in each CPT code by assigning a number of relative value units (RVUs) to the code. CMS also establishes an annual conversion factor per RVU to determine the fee for the service.
For 2024, the average proposed conversion factor will be $32.74, which is a 3.34% decrease from 2023.1 The conversion factor can vary based on the geographic location of the provider and patient.
Annual changes are also made to ICD-10 diagnosis codes. For 2024, there are 395 new codes, 25 deleted codes, and 22 revised codes. These include 34 new eye codes, one deleted eye code, and one revised eye code.2
New ICD-10 codes to know
Several new codes in the H36.8- group involve sickle cell retinopathy. There are also several new codes related to eye movement disorders due to the entrapment of the various extraocular muscles in the H50.6 code group.2
Another new set of codes is in the H54.0- and H54.1 code groups. These are all related to the categorization of patients with low vision problems.2
The last major change is the addition of a code group, H57.8A-, for foreign body sensation (ocular). This is what is called a “symptom” code and can only be used when the cause of the foreign body sensation can not be determined.
ICD-10 codes for social determinants of health
Another diagnosis code group that has grown significantly over the past few years is in the Z55-65 area of the Social Determinants of Health (SDoH) codes. These codes are related to various aspects of a patient’s life, such as homelessness or low income, which may affect their access or response to healthcare services.
If a patient is being seen by a provider and the provider feels that the patient’s SDoH may affect their ability to comply with treatment, the applicable SDoH(s) should be documented. When the SDoH codes are submitted on the claim, in addition to the regular diagnosis codes, they may increase the level and risk of their problem—as applied to Medical Decision Making code determination.
Significant CPT changes
The CPT changes for 2024 include 230 new codes—most of which apply to lab tests, 49 deleted codes, and 70 revised codes. ECPs will notice the elimination of the time ranges for the 99202 to 99215 E/M codes, used when selecting the E/M code based on doctor time spent with a patient on a date of service.
For example, the 2023 descriptor for the 99203 code has a time range of 30 to 44 minutes. The 2024 descriptor will just state that time was equal to or greater than 30 minutes.3
CMS has also stated, “Reviewers will use the medical record documentation to objectively determine the medical necessity of the visit and accuracy of the documentation of the time spent” when an E/M code is billed based on time.4 Therefore, it is still critical to carefully and accurately document what was done during the patient visit in order to justify the time spent with them.
HCPCS code G2211
CMS has added a new Healthcare Common Procedure Coding System (HCPCS) code, G2211, which is to be billed in addition to the 99202 to 99215 code when caring for complex cases.
CMS estimates that the code will be used for 38 to 54% of claims submitted by primary care providers (PCPs) and certain specialists.5
The key to using G2211
The G2211 is only to be used when a provider is treating a single serious or complex condition with consistency over a long period of time. The key to using this code is that a provider is treating the condition over an extended period of time. Therefore, CMS does not feel that surgical specialists will bill the code because their surgical treatment of the patient most likely will not extend over a long period of time.
CMS reports, “We also estimated that the E/M complexity add-on service would be reported by specialists that rely on office/outpatient E/M visits to report the majority of their services.” The impetus behind this new code is that CMS believes that the reimbursement for an E/M code is not adequate when the cost of caring for patients with long-term complex conditions is taken into account.1
Patients with acute problems such as seasonal allergies and bacterial infections or patients referred for procedures, such as mole removal or cataract and oculoplastic surgery, would not be included in the groups this code would be applicable to.1
Changes to the MIPS program
Finally, CMS is going to require that those providers participating in the Merit-Based Incentive Payment System (MIPS) program reach a higher performance threshold of 82 points versus the 75 required for 2023.
CMS estimates that 54% of MIPS participating physicians will not reach that threshold and be penalized through up to a 9% fee reduction instituted in 2026.1
Final thoughts
In the landscape of today’s healthcare system, there are myriad obstacles to providing quality patient care. Billing and coding, when performed incorrectly, can unfortunately be one of these obstacles.
Paying close attention to these CMS changes for 2024 will help in more accurate diagnosis coding and assure that healthcare providers are properly reimbursed for their services.
