The Hospital Finance Podcast®

2022 Inpatient and Outpatient Coding Updates [PODCAST]

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The Hospital Finance Podcast

In this episode, we are joined by Sandy Brewton, Senior Healthcare Consultant at Panacea Healthcare Solutions, to talk about both inpatient and outpatient coding changes that will affect you in 2022.

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Highlights of this episode include:

  • How many new codes have been created
  • When the new codes will be effective
  • What type of procedures are included
  • Added diagnosis codes for COVID-19
  • The impact these changes will have on coding and reporting in 2022

Mike Passanante: Hi, this is Mike Passanante and welcome back to the award-winning Hospital Finance podcast. Each year, CMS issues several coding-related changes that, really, can impact how a hospital bills. And this year, I am joined by Sandy Brewton, who is a senior healthcare consultant at Panacea Healthcare Solutions, to talk about both inpatient and outpatient coding changes that will affect you in 2022. Sandy, welcome back to the show.

Sandy Brewton: Thanks, Mike.

Mike: So, Sandy, CMS has recently announced new diagnosis and procedure codes for fiscal year 2022, as we just intimated. How many new codes have been created and when will they be effective?

Sandy: Well, hold onto your hat, because I’m going to throw out a bunch of numbers here. So for fiscal year 2022, there are 159 new diagnosis codes. There were 32 deleted diagnosis codes, and revised, 20 diagnosis codes, overall. The total number of valid diagnosis codes for 2022 is 72,748. Now, overall, for ICD-10-CM/PCS procedure codes, there are 191 new procedure codes. They deleted 107 procedure codes and revised 62 procedure codes for 2022. So the grand total of PCS procedure codes for 2022 is 78,220. For outpatient procedure coding, there are about 249 new CPT procedure codes for 2022. They deleted 63 CPT procedure codes and revised 93 CPT procedure codes. Now, the new diagnosis and ICD-10-PCS codes are already in effect as of October 1st this year, which is, actually, the beginning of the fiscal year for 2022. The new CPT codes, however, are on a calendar year and those procedure codes will go into effect as of January 1st of 2022.

Mike: So that sounds like quite a large number of new procedure codes across the code sets. What type of procedures are included in the new procedure codes?

Sandy: So the new procedures really span across the code sets. For instance, in the outpatient CPT procedure code set, some important additions are to the fast-growing digital medicine services. Five new CPT codes, 98975 through 98981 were created to report therapeutic remote monitoring of patients. You know this as telehealth. This type of remote care became an increasingly common avenue of patient care during the COVID-19 pandemic. And to support these new codes and telehealth services, in general, a new appendix is also included in the 2022 CPT code set, and that provides a taxonomy for digital medicine services. The purpose of this appendix is to support increased awareness and increased understanding of the approaches to patient care through the multifaceted digital medicine services that they’re available for reporting in the CPT code set. Now, there’s another important note for 2022, there was talk that CMS was going to eliminate the inpatient-only list in the OPPS Final Rule. But at the time the final OPPS rule was published, they halted elimination of the inpatient-only list. They had received feedback that some providers wanted to keep the inpatient-only list, and in fact, CMS has added back the over 200 procedure codes that they removed this year from the list in their first-phase preparation of getting rid of that list, except for about 8 CPT codes. So they’ve abandoned that, and we’ll have to keep an eye on that going forward, see if they’re going to try to implement getting rid of inpatient-only list again.

Now, to summarize the new procedure codes in ICD-10-PCS for 2022, many of the new procedure codes are for new body part characters that were added to existing code tables. For example, body part coronary artery was added to the fragmentation table. And that’s to capture that newer procedure of intravascular shockwave lithotripsy, and that’s often performed during a coronary artery angiography with dilation. Now, some breaking news, however, for the ICD-10-PCS procedure code set, as of December 1st this year, there’s been an additional update to the code set for fiscal year 2022. And that is the addition of seven new procedure codes. Four of these new procedure codes are to capture a third dose or booster dose of the COVID-19 vaccine introduced either into the subcutaneous tissue or into the muscle. The other three new procedure codes, added just 10 days ago on December 1st, are for the introduction of fostamatinib into the mouth and pharynx or into the upper GI tract and into the lower GI tract. Now, fostamatinib is a drug that was approved in April of 2018 by the FDA to treat chronic immune thrombocytopenia. And now, we’ll have three PCS codes to be able to capture the administration of this fairly new treatment.

Also of note, for 2022, the Centers for Medicare and Medicaid Services added a new measure to the hospital inpatient quality reporting program that will require hospitals to report the percentage of healthcare personnel who have received a complete vaccination against COVID-19. Now, the first reporting period spans October 1 of this year through December 31st and will be applicable for payments in fiscal year 2023. Now, after this initial reporting period, which has almost come to a close, hospitals will be required to submit data on a quarterly basis beginning in January of 2022, and that will be for fiscal year 2024-and-later payment determinations. Now, Mike, I’ve heard there’s been some legal action concerning CMS requirement of COVID-19 vaccinations. So we’re going to have to check in as 2022 progresses to find out if there are any changes to this particular new IQR measure.

Mike: All right. And, Sandy, you mentioned that CMS also released some new diagnosis codes. Are these diagnosis codes for COVID-19 or for other conditions as well?

Sandy: Well, in the diagnosis coding changes for 2022, there were numerous diagnoses that were expanded for more specificity, and that, really, is the majority of the changes for the diagnosis codes. However, there are some interesting new diagnosis codes worthy of mention. So, for example, we, finally, have a more appropriate diagnosis code for unspecified depression. Previously, unspecified depression was coded as major depressive disorder, single episode, and that would raise the DRG payment. Now, we have the diagnosis code F32.A depression, unspecified, with which to capture unspecified depression. This code will not raise DRG payment and is much more appropriate for non-specific depression documentation. Now, we were given another new code pertaining to COVID-19. This new code comes after more information is known about possible after-effects of a COVID-19 infection. Some of the possible long-term effects of COVID are prolonged loss of smell and/or taste, chronic respiratory failure, pneumonia, acute respiratory distress syndrome. This new diagnosis code for fiscal year 2022 is U09.9 post-COVID-19 condition, unspecified. Now, this code was, actually, added by the World Health Organization, and ICD-10-CM decided that they were also going to implement the same code. There’s also a new guideline that accompanies this new diagnosis code, spelling out coding instructions for code assignment. Now, also related to the COVID-19 pandemic, we have a new diagnosis code to capture an Encounter for Immunization Safety Counseling Z71.85. This code is to capture when a patient comes to their physician asking about vaccine product safety. Accounting for a good number of diagnosis code additions for 2022 is also the addition of numerous Z-codes to capture social determinants of health and personal history information. These codes will allow providers to capture whether a patient has conditions such as, less than a high school diploma, homelessness, living in a shelter, or has housing instability, has a lack of adequate food supply and safe drinking water, or has an inadequate access to drinking water. Personal history information that will now be able to be captured are situations such as suicidal behavior, non-suicidal self-harm, such as cutting, whether or not a patient is on immunosuppressive therapy and more. CMS is really focused on capturing the social determinants of health data and personal history data in the coming years.

Mike: So Sandy, we talked about a variety of changes. What impact, if any, will these have on coding and reporting in 2022?

Sandy: Overall, the changes and additions to all of the code sets is really the smallest that we’ve seen in years. In previous years, we’ve had larger and much more widespread changes to each of the code sets, and I really suspect this is due to the focus on the COVID pandemic in 2020 and in 2021. Of note, beginning in 2022 and beyond, there will now be two IPPS code updates per year. In April of 2022, we will have the first mid-year update to the IPPS. They’ve indicated this will be a small update, initially, and that we will continue to have our normal October 1st IPPS Final Rule updates every year as well. So stay tuned for that. We’ll see how that goes.

Mike: Yeah, that’ll be an interesting change. Sandy, if someone wanted to find more information on these new codes and the implementation dates, where can they go?

Sandy: Anyone who would like to read the juicy details can visit the CMS website and search for the fiscal year 2022 IPPS Final Rule, the calendar year OPPS 2022 Final Rule, and the code tables for 2022.

Mike: Sandy Brewton, thanks so much for joining us today on The Hospital Finance Podcast.

Sandy: Thanks for having me, Mike.

The Hospital Finance Podcast

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