When compared to other specialties, billing and coding for general surgery can be especially complex. There are a wide range of major and minor surgical procedures, each with an extensive set of guidelines and annual updates to the corresponding codes. Partnering with a general surgery medical billing company is a practical approach for ensuring precise claim submission to optimize your reimbursement
In 2024, there are numerous coding changes impacting general surgery and related specialties.
This post focuses on the updates in following areas as reported in an article from the American College of Surgeons (ACS):
- Evaluation and Management and Prolonged Services Codes
- Hyperthermic Intraperitoneal Chemotherapy
- Critical Care Services
- Hospital Inpatient or Observation Care Services for Short Stays
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CPT Code Changes for General Surgery in 2024
- Evaluation and Management and Prolonged Services Codes
The 2024 E/M CPT changes are minimal but important, and relate to “time.”
The time ranges from both the new and established office/outpatient E/M codes (99202-99215) have been removed and replaced with a minimum time requirement when using time to select a level of E/M service. This is the lowest number of minutes in the current range for each code and this time “must be met or exceeded.”
For example, take: CPT code 99202, Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making
In 2023, code 99202 had a time range of 15-29 minutes – the “total time … spent on the date of the encounter.”
Beginning Jan. 1, 2024, the descriptor for this E/M codes no longer includes a time range. The provider must meet or exceed 15 minutes of total service time before billing code 99202 by time.
Points to note:
- There is no change in the descriptor for CPT code 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional). In 2024, this code is billed as done previously.
- For Medicare claims, HCPCS codes must be when reporting prolonged services codes. Other insurance payers may require reporting HCPCS codes in accordance with CMS policies or may permit the use of CPT prolonged services codes and CPT policy.
The following table shows the 2024 CPT vs. HCPCS prolonged services time threshold reporting guidelines
| Primary E/M Service
(minimum time on date of encounter) |
CPT Prolonged Services Codes |
CPT Time Threshold |
Medicare Prolonged Services Codes |
Medicare Time Threshold |
|---|---|---|---|---|
|
99205 New Patient Office Visit |
99417 |
75 minutes |
G2212 |
90 minutes |
|
99215 Established Patient Office Visit |
99417 |
55 minutes |
G2212 |
70 minutes |
|
99223 Initial Inpatient or Observation Visit |
99418 |
90 minutes |
G0316 |
105 minutes |
|
99233 Subsequent Inpatient or Observation Visit |
99418 |
65 minutes |
G0316 |
80 minutes |
- Hyperthermic Intraperitoneal Chemotherapy
There are two new add-on time-based codes for reporting intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC):
CPT code 96547, Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; first 60 minutes (List separately in addition to code for primary procedure)
CPT code 96548, Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; each additional 30 minutes (List separately in addition to code for primary procedure).
The HIPEC procedure includes chemotherapy agent selection, confirmation of perfusion equipment settings for chemotherapy agent delivery, additional incision(s) for catheter and temperature probe placement, perfusion supervision and manual agitation of the heated chemotherapy agent in the abdominal cavity during chemotherapy agent dwell time, irrigation of the chemotherapy agent, closure of wounds related to HIPEC, and documentation of the chemotherapy agent and HIPEC procedure in the medical record.
Reporting 96547 and 96548:
- Codes 96547 and 96548 are reported based on the surgeon’s total time for both face-to-face and non-face-to-face activities related to the HIPEC procedure.
- Report these codes only when the midpoint of the time in the code descriptor has been reached. Code 96547 may not be reported until at least 31 minutes have been reached, unless the procedure is discontinued (e.g., the patient becomes unstable or has an allergic reaction to the chemo agent) in which case modifier 53 discontinued procedure should be appended to the code.
- Code 96548 may be reported after an additional 16 minutes of the HIPEC procedure above the initial 60 minutes reported with code 96547 has been reached (i.e., 76 minutes of total time).
- When reporting 96547 and 96548, do not include time for the typical preoperative, intraoperative, and postoperative work related to the primary procedure(s) that may be separately reported.
- Critical Care Services
Unlike the new code descriptors for office and hospital E/M codes which include a minimum time, the critical care code (99291, 99292) descriptors still include time ranges.
- CPT and CMS rules differ with regards to when it would be appropriate to report code 99292 for each additional 30 minutes of critical care services:
- CMS requires that 99292 should be reported after a full 30 minutes of service above the maximum time in the time range for this code.
- CPT instructs that 99292 can be reported after one minute or additional time.
- Hospital Inpatient or Observation Care Services for Short Stays
CPT codes 99234-99236, observation or inpatient care, are used when the patient is placed in observation status or admitted to inpatient status and then discharged on the same date. All services provided on the day of discharge from inpatient status are coded 99238 or 99239.
According to the 2024 guidelines:
- CPT codes 99234-99236 are only to be reported by a provider who performs both the initial and discharge services on a single date of service and when the patient stay is more than 8 hours.
- Only one physician may report same date admit/discharge codes 99234-99236; two or more separate and distinct patient encounters are required to report these codes.
- Other physicians who also provide an E/M service may report 99221-99223, as appropriate.
- Report only codes 99221-99223 when a patient receives hospital inpatient or observation care for fewer than 8 hours.
- For patients admitted to hospital inpatient or observation care and discharged on a different date, report the appropriate level of hospital E/M service on the first date, and the appropriate discharge service on the subsequent date.
- If the surgeon does not admit the patient to inpatient or observation care and instead consults on one or more days, report the inpatient/observation E/M codes 99221-99223 and 99231-99233 as appropriate.
General surgery medical coding is set to see more changes in 2025, according to the ACS. Professional expertise is crucial for general surgery medical billing and coding. Reach out to a company with AAPC certified coders to ensure accurate and timely billing, coding, and claims submission.
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