New 2022 CPT Codes Changes
405 Total Changes
10,819 Total codes in 2022 code set
Update from the Centers for Medicare and Medicaid Services (CMS)
Split (or Shared) Visits
- A clarification was made in CY 2022 that defined a split (or shared) visit as an E/M visit in the facility setting performed in part by both a physician and a nonphysician practitioner (NPP) from the same group, such that the service could be billed by either the physician or NPP if furnished independently by only one of them.
Billing for a split (or shared) service must be in accordance with applicable law, regulations and individual state scope of practice.
Payment will be made to the practitioner who performs the substantive portion of the visit.
For 2022, the substantive portion can be one of the 3 key components (history, physical exam, or medical decision-making), or more than half of the total time (except for critical care, which can only be more than half of the total time).
Beginning in 2023, the substantive portion of the visit will be defined as more than half of the total time spent by the physician and NPP.
In the office setting, when both a physician and NPP of the same group have furnished a service, (since split or shared visits apply to the facility setting), it is recommended that “incident to” be billed.
Split (or shared) visits can be reported for new and established patients, initial and subsequent visits, and prolonged services.
Documentation in the medical record must identify the two individuals who performed the visit.
The individual providing the substantive portion must sign and date the medical record.
Teaching Physician Services (Visit Level Selection)
Clarifications were made regarding when time is to be used to select the E/M visit level for Teaching Physician Services
Only the time of the teaching physician may be included (including, but not limited to time spent being present with the resident).
Time spent independently by the resident cannot be included.
Coinsurance For Colorectal Cancer Screening
CMS finalized implementation of Section 122 of the CAA (Consolidated Appropriations Act) which provides a special coinsurance rule for procedures planned as colorectal cancer screening tests but which become diagnostic tests when the practitioner identifies the need for additional services (e.g., removal of polyps).
The provision calls for a gradual phase down of beneficiary coinsurance liability from 20 percent beginning in CY 2022, with a final transition in CY 2030 to 0 percent.
Billing For Physician Assistant (PA) Services
Beginning January 1, 2022 (as part of the CAA), Medicare will make direct payment to physician assistants (PAs) for professional services they furnish under Part B.
Medicare can currently only make payment to the employer or independent contractor of a PA.
Beginning January 1, 2022, PAs may bill Medicare directly for their professional services, reassign payment for their professional services, and incorporate with other PAs and bill Medicare for PA services.
Certified Professional Coder, Director of Physician Education
Kim Snyder is a Certified Professional Coder (CPC) with more than 20 years of experience in healthcare coding and compliance. She joined MSN Healthcare Solutions in 2016 and currently serves as Director of Physician Education, specializing in the development of educational materials and programs designed to improve complete and compliant documentation.
This educational guide was prepared as a tool to provide education for documentation and coding. It is not intended to affect clinical treatment patterns. The material provided is for informational purposes only. Efforts have been made to ensure the information within this document was accurate on the date of distribution. Reimbursement policies vary from insurer to insurer and the policies of the same payer may vary within different U.S. regions. All policies should be verified to ensure compliance. CPT® codes, descriptions and other data are copyright of the American Medical Association (or such other date of publication of CPT®).All Rights Reserved. CPT® is a registered trademark of the American Medical Association. Proprietary and confidential document. All rights reserved. No part of this document may be reproduced or used in any manner without the written permission of MSN Healthcare Solutions, LLC.