Procedural Coding Changes to Note for 2024

As is usual for this time of year, lab leaders will want to examine coding changes identified by the American Medical Association (AMA) to go into effect on January 1, 2024.¹ These changes must be incorporated into laboratory billing software—chargemasters in the facility setting and fee schedules in independent settings. These changes are crucial for accurate billing and resulting reimbursement as well as for compliance with government regulations and billing transparency.

Laboratory coding changes

New codes

Six new molecular procedural codes were added, grouped into two “families” of three codes each:

To accompany these new codes, definitions of various code components were included:

Cell-free nucleic acid: DNA or RNA released into the blood and other body fluids. Cell-free nucleic acid released from fetal cells can be sampled for non-invasive prenatal testing (NIPT), while that released from tumor cells can be sampled for cancer, sometimes referred to as tumor liquid biopsy.

Copy number variants (CNVs): structural changes in the genome which are composed of large deletions or duplications. CNVs can be found in the germline but can also occur in somatic cells. See also Duplication/Deletion (Dup/Del). Duplications may also be referred to as amplifications.

Duplication/Deletion (Dup/Del): terms that are usually used together with the “/” to refer to molecular testing, which assesses the dosage of a particular genomic region. The region tested is typically of modest to substantial size, from several dozen to several million or more nucleotides. Normal gene dosage is two copies per cell, except for the sex chromosomes (X and Y). Thus, zero or one copy represents a deletion, and three (or more) copies represent a duplication.

Massively parallel sequencing (MPS): high-throughput method used to determine a portion of the nucleotide sequences in an individual patient’s genome, utilizing advanced (non-Sanger) sequencing technologies that are capable of processing multiple DNA and/or RNA sequences in parallel. While other technologies exist, next-generation sequencing (NGS) is a common technique used to achieve MPS.

Microsatellite instability (MSI): a type of DNA hypermutation or predisposition to mutation in which replication errors are not corrected due to defective DNA mismatch repair (dMMR) mechanism. MSI manifests as insertions or deletions in short tandem repeat (STR) (defined in the molecular pathology guidelines) alleles and can be identified by changes in the DNA repeat sequence length.

Rearrangements: structural chromosomal variations such as deletions, insertions, inversions (defined in the molecular pathology guidelines), or translocations (defined in the molecular pathology guidelines) that bring together genetic material that is not normally adjacent in the unmodified genome. It can manifest as abnormal gene expression or as an abnormal fusion product at the RNA and/or protein level. Rearrangement can also refer to the process by which immunoglobulin and T cell receptor genes are normally modified.

Tumor mutational burden (TMB): the number of somatic mutations detected per million bases (megabases [Mb]) of genomic sequence investigated from a cancer specimen. It is usually obtained from analysis using a next-generation sequencing method. It is considered a biomarker to guide immunotherapy decisions for patients with cancer.

Two MAAA (multianalyte assay with algorithmic analyses) codes were added for 2024:

The chemistry, immunology, and microbiology sections also have newly added codes:

There are 61 new PLA (Proprietary Laboratory Analysis) codes printed in Current Procedural Terminology (CPT) for 2024—too many to detail here. Some of these PLAs were adopted throughout 2023 for printing in 2024. Many relate to oncology testing and several to infectious disease testing.

Digital pathology codes

The only new codes for pathology relate to digital preparations. Thirteen new codes were added for the 2023 calendar year to address digital preps for surgical pathology codes (CPT 88302 – 88309), special stains (CPT 88312, 88313, 88314, 88319) and immunohistochemistry (IHC) stains (88342, 88341, 88344, 88360). Thirty more codes were added for 2024 and encompass any remaining pathology disciplines not covered in 2023:

These digital pathology codes are Category III Codes which are listed in a separate section of the CPT Codebook. Each of the above CPT codes is linked to a specific digital prep code; these digital codes are add-on codes preceded by a “+” sign. Note the following examples:

While these codes are seemingly not yet recognized for reimbursement, it is important for labs to report them. If the codes are not utilized, they will not become Category I CPT codes or will be deleted after a five-year period.

Procedural coding description changes

In addition to adding applicable new codes to the chargemaster, it is important to determine if any description changes impact the coding accuracy for billing. Ask if any changes in procedural descriptions impact the intent of testing and current coding. Make appropriate changes in the billing software. The following codes and their descriptions should be reviewed to determine if they impact laboratory performance:

While the above procedures apply to molecular testing, several PLA codes were also tagged with description changes. Determine if these procedures are performed:

PLA Code

0022U
0095U
0269U
0271U
0272U
0274U
0277U
0278U
0308U
0362U

Procedural code deletions

When codes are deleted from the CPT Codebook, they should also be deleted from billing software as they are no longer recognized for reimbursement. Deletion prevents reporting them in err. Note the following deleted PLA codes and an MAAA code:

Deleted codes

0012U                                                 0143U                                                 0324U
0013U                                                 0144U                                                 0325U
0014U                                                 0145U                                                 0357U
0053U                                                 0146U                                                 0386U
0056U                                                 0147U                                                 0397U
0066U                                                 0148U                                                 0014M
0097U                                                 0149U
0098U                                                 0150U
0099U                                                 0151U
0100U                                                 0208U

General recommendations:

• Remember to pay attention to the parenthetical comments in the Codebook; they provide valuable instructions for code usage.
• Peruse your organization’s chargemaster/fee schedule to confirm accuracy for coding, correct all service entries for units of service, evaluate whether low fees exist, and ensure that descriptions are accurate.
• Research coding intent and application beyond the printed description for appropriate reporting.
• While this article focuses on procedural codes, ICD-10 codes should also be reviewed; they change annually on October 1.
• This is also a great time of year to review NCD (National Coverage Determinations) and LCD (Local Coverage Determinations) content for year-end updates that reflect both procedural and diagnosis coding changes. Don’t forget to include commercial payer policies as well.

Carefully reviewing these changes and ensuring they are properly reflected in chargemasters and fee schedules is essential for lab leaders and billing and coding departments to avoid mistakes.

References:

1. https://www.ama-assn.org/press-center/press-releases/ama-releases-cpt-2024-code-set

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Diana W. Voorhees, MA, MLS(ASCP)SH, CLCP, CPCO, is principal in DV & Associates, Inc., Salt Lake City, UT, which makes no representation, guarantee, or warranty, expressed or implied, that the information provided is free of error, and will bear no responsibility or liability for results or consequences of its use.