Prepare for 2024 E/M changes and FY 2023 ICD-10-CM codes
With the year winding down, now is a good time for healthcare practices and billing companies (on behalf of their clients) to ensure compliance with billing code changes that took effect October 1, 2023, and prepare for changes that become effective January 1, 2024. Discover what’s new for evaluation and management (E/M) codes and ICD-10-CM diagnosis codes that could affect your medical practice.
At a Glance
- CPT code changes taking effect in 2024 include removing time ranges from E/M codes 99202-99205 and 99212-99215, and providing a new definition for split/shared E/M visits.
- ICD-10-CM code changes effective Oct 1, 2023 provide greater specificity for conditions like resistant hypertension, metabolic disorders, and more.
- To prepare for the code changes, practices should focus on coder education, loop in physicians on documentation needs, and audit claims to ensure compliance and prevent denials.
Medical code changes happen every year, and it can be overwhelming to keep track of what codes are new, revised, and deleted. This article highlights several important changes to evaluation and management (E/M) codes that take effect January 1, 2024, as well as several ICD-10-CM diagnosis code changes that became effective October 1, 2023. Our goal is to help you ensure clean claims, reduce denials, and promote revenue integrity in your medical practice.
Notable changes to E/M codes
In the 2024 CPT code update, you’ll find notable E/M-related changes for:
- Codes 99202-99205 and 99212-99215. The American Medical Association (AMA) removed time ranges from these codes to align their format with that of other E/M codes.
- Split/shared E/M visits. The AMA provides a new definition to determine the substantive portion of a visit in which a physician and non-physician practitioner work jointly to furnish all of the work related to the visit.
In total, the annual update to the CPT code set created 349 editorial changes, including 230 additions, 49 deletions, and 70 revisions. This includes the consolidation of more than 50 previous codes that streamline the reporting of immunizations for COVID-19.
The CPT Editorial Panel also approved the provisional codes (91318-91322) to identify monovalent vaccine products from Moderna and Pfizer for immunization against COVID-19.
Notable changes to ICD-10-CM codes
The fiscal year (FY) 2024 ICD-10-CM code updates that took effect October 1, 20223 includes 395 code additions, 25 code deletions, and 13 code revisions. Here are some of the most notable changes:
1. Resistant hypertension
A new ICD-10-CM diagnosis code for resistant hypertension (I1A.0) captures cases where a patient’s hypertension does not respond well to aggressive medical treatment.
2. Metabolic disorders and insulin resistance
Four new codes for metabolic disorders replace ICD-10-CM diagnosis code E88.81 (metabolic syndrome):
- E88.810 - Metabolic syndrome, dysmetabolic syndrome X
- E88.811 - Insulin resistance syndrome, Type A
- E88.818 - Other insulin resistance, Insulin resistance, Type B
- E88.819 - Insulin resistance, unspecified
3. Chronic migraines
New ICD-10-CM diagnosis code for chronic migraine with aura (G43.E) provides additional specificity in terms of ‘intractable vs. not intractable’ and ‘with or without status migrainosus.’
4. Parkinson’s disease
Four new, more specific ICD-10-CM diagnosis codes for Parkinson’s disease replace ICD-10-CM code G20 (Parkinson’s disease):
- G20.A1 - Parkinson's disease without dyskinesia, without mention of fluctuations
- G20.A2 - Parkinson's disease without dyskinesia, with fluctuations
- G20.B1 - Parkinson's disease with dyskinesia, without mention of fluctuations
- G20.B2 - Parkinson's disease with dyskinesia, with fluctuations
There’s also a new ICD-10-CM diagnosis code for unspecified Parkinsonism (G20.C). This is a general healthcare term for a group of neurological disorders causing movement problems similar to those seen in Parkinson’s disease (e.g., tremors, slow movement, and stiffness).
“There’s also a new ICD-10-CM diagnosis code for unspecified Parkinsonism (G20.C). ”
CPT no longer includes ICD-10-CM diagnosis code J15.6 (pneumonia due to other gram-negative bacteria). Instead, report 1 of these 2 new, more specific medical codes:
- J15.61 - Pneumonia due to Acinetobacter baumannii
- J15.69 - Pneumonia due to other Gram-negative bacteria
6. Dense breasts
There’s a new ICD-10-CM diagnosis code for dense breasts, unspecified (R92.3).
7. Child custody
Be sure to put these two new ICD-10-CM diagnosis codes on your radar:
- Z62.23 - Child in custody of non-parental relative
- Z62.24 - Child in custody of non-relative guardian
8. Familial conflict
Similarly, make sure you’re aware of these five new ICD-10-CM diagnosis codes for conflicts children may have with relatives or guardians:
- Z62.823 - Parent-step child conflict
- Z62.83 - Non-parental relative or guardian-child conflict
- Z62.831 - Non-parental relative-child conflict
- Z62.832 - Non-relative guardian-child conflict
- Z62.833 - Group home staff/child conflict
9. Caregiver noncompliance
Finally, note that there are 2 new ICD-10-CM diagnosis codes for noncompliance due to financial hardship:
- Z91.A41 - Caregiver’s other noncompliance with patient’s medication regimen due to financial hardship
- Z91.A51 - Caregiver's noncompliance with patient’s renal dialysis due to financial hardship
3 strategies to prepare for the changes
Consider these 3 strategies to ensure a compliant healthcare revenue cycle and promote revenue integrity in your medical practice:
1. Focus on coder education
Ensure coders understand the new codes and review the FY 2024 ICD-10-CM official guidelines for coding and reporting that provide additional reporting instructions. In this article, we’ve only provided a snapshot of the changes. There are plenty of other new codes that may also affect your medical practice and specialty.
“There are plenty of other new codes that may also affect your medical practice and specialty. ”
2. Loop physicians into the changes
Educate physicians and other providers who document in the medical record to ensure their documentation supports the additional specificity inherent in many of the new codes.
3. Audit claims
The new ICD-10-CM diagnosis codes have been in effect for almost a month, and now is a great time to audit claims. Plan to do the same again in January or February after the new CPT codes take effect.
Report new codes with confidence to avoid denials
The 4th quarter is always a busy time of year for medical practices, and understanding new medical codes can pose a challenge. However, with a bit of proactive planning and education, coders, physicians, and others will be able to report new codes with confidence and avoid denials.
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