Navigating Change: What You Need to Know About the CPT 2024 Updates

Split (or Shared) Visits:

Determining which team member reports the visit is based on calculating the substantive portion of the encounter:

• If code selection relies on total time, the professional who spends the majority or more than half of the face-to-face or non-face-to-face time performing the service reports it.
• Alternatively, if a practice codes the visit based on medical decision-making (MDM), the practitioner handling the problems addressed and risk portions of the visit reports the service.

Hospital Inpatient, Observation, Admission, and Discharge Services:

The guidelines for hospital inpatient or observation care services, as well as admission and discharge services, entail specific nuances:

• Services such as hospital inpatient care, observation care, and nursing facility services are considered on a per-day basis, consolidating multiple visits occurring within a single calendar date in the same setting into a single reported service.
• When employing MDM for code level selection, the aggregated MDM throughout the calendar date is utilized. When using time for code level selection, the time is summed over the course of the day based on reporting time guidelines.
• Transfers between different designated facilities or levels of care may not necessarily constitute a new stay or a transfer to a different facility, depending on specific criteria.
• When a physician or other Qualified Healthcare Professional (QHP) offers subsequent E/M services and doesn’t report ED sets but reports a different E/M service (e.g., hospital inpatient or observation care services), the time spent in the ED can contribute to the total time calculation for that encounter date.

Pelvic examination:

CPT® 99459 is a code specifically covering direct practice expenses. It allows billing alongside E/M services when practitioners conduct a pelvic exam as part of an E/M service provided to patients.