2023 CPT Coding Changes

2023 CPT® Coding Updates
Anitha Jayaseelan CPC, CIRCC

Disclaimer
This presentation is designed to offer basic information for
coding and billing. The information presented here is based
on the experience, training and interpretation of the author.
Although the information has been carefully researched and
checked for accuracy and completeness, the instructor does
not accept any responsibility or liability with regard to errors,
omissions, misuse or misinterpretation. This material is
intended as an Educational guide and should not be
considered a legal/consulting opinion.
Learning Objectives
Synopsis of 2023 CPT® code changes
CPT® Section wise detailed changes for 2023
Revised codes and Revised descriptions
Deleted codes of 2023 and their Replacement codes
New codes added for 2023
Coding guidelines for New & Revised code

2023 CPT Updates
Synopsis :
● - 225 Additions
▲ - 93 Revisions
Del - 75 Deletions
● = New Code
▲ = Revised Code
Del = Deleted Code
An overview on 2023 CPT Updates
 There are coding and guidelines changes in every section
of the CPT 2023 code set except Anaesthesia.
 The most significant changes are to the E/M, percutaneous
pulmonary artery revascularization, hernia repairs, lab &
Pathology, Covid-19 vaccination codes.
 Also 2 new appendices are added
 Artificial Intelligence(AI) taxonomy (Appendix S)
 Synchronous real-time interactive audio-only telemedicine services
(Appendix T).
2023 CPT Updates - Summary
Male
Changes Integumentary Musculoskeletal Respiratory CVS Digestive Urinary
Genital
Additions 3 1 1 7 17 0 1
Revisions 1 2 0 1 0 2 0
Deletions 1 0 0 0 18 0 0
2023 CPT Updates - Summary
Eye and Pathology

Changes Nervous Ocular Auditory Radiology and Medicine Category III
Adnexa Laboratory
Additions 0 0 3 1 11 10 46
Revisions 7 2 5 5 3 7 2
Deletions 0 0 0 0 0 23 23
Evaluation and Management Updates
There are a lots of changes to unpack in this section and a thorough review is necessary.
Following are the highlights of EM updates in 2023
 Introductory Guidelines related to Hospital Inpatient and Observation Care
Services codes, Consultations codes, Emergency Department Services codes,
Nursing Facility Services codes, Home or Residence Services codes
 Hospital Observation Services E/M codes 99217-99220 are deleted.
 Hospital Inpatient and Observation Care Services E/M codes and guidelines are
revised
 Consultations E/M codes 99241 and 99251 are deleted

 Consultations E/M codes 99242-99245, 99252-99255 and Guidelines are revised
 Emergency Department Services E/M codes 99281-99285 and guidelines are revised
 Nursing Facility Services E/M code 99318 is deleted
 Nursing Facility Services E/M codes 99304-99310, 99315, 99316 and guidelines are revised
 Domiciliary, Rest Home (eg, Boarding Home), or Custodial Care Services E/M codes 99324-
99238, 99334-99337, 99339, 99340 are deleted
 Home or Residence Services E/M code 99343 is deleted

 Home or Residence Services E/M codes 99341, 99342, 99344, 99345,
99347-99350 and guidelines are revised
 Prolonged Services E/M codes 99354-99357 are deleted
 Guidelines for Prolonged Services E/M codes 99358, 99359, 99415, 99416
are revised
 Prolonged Services E/M code 99417 and guidelines are revised
 New add-on code for Prolonged Services 99418

Surgery Section Changes
Surgery Section :
The surgery section of the CPT manual will include updates to several of the
subsections, starting with the integumentary system.
Surgery Section Changes – Integumentary System
Integumentary System :
This section will include three new codes, one deletion, and one revision
including updates for removal of sutures/staples and implantation of absorbable
mesh or other prosthesis for delayed closure defects:
● 15778 - Implantation of absorbable mesh or other prosthesis for delayed closure

of defect(s) (ie, external genitalia, perineum, abdominal wall) due to soft tissue
infection or trauma
Integumentary System :
The 2 new add-on codes allows us to capture practice expense when sutures or
staples are removed in the office at the time of E/M service
● +15853 Removal of sutures or staples not requiring anesthesia
(List separately in addition to E/M code)
● + 15854 Removal of sutures and staples not requiring anesthesia
(List separately in addition to E/M code)

There are three new codes in the integumentary system section, plus one deletion
and one revision:
▲15851 - Removal of sutures or staples requiring anesthesia
(ie, general anesthesia, moderate sedation)
Del
15850 - Removal of sutures under anesthesia (other than local), same surgeon
Surgery Section Changes – Musculoskeletal system
Musculoskeletal System :
One new add-on code (22860) in the musculoskeletal system section describes a
total disc arthroplasty and discectomy to prepare an interspace. Codes 22857 and
27280 have minor revisions to their long descriptors.
● +22860 - Total disc arthroplasty (artificial disc), anterior approach, including

discectomy to prepare interspace (other than for decompression); second
interspace, lumbar
(List separately in addition to code for primary procedure)
▲ 22857 - Total disc arthroplasty (artificial disc), anterior approach, including
discectomy to prepare interspace (other than for decompression); single interspace,
lumbar
This code is revised to make Single interspace, lumbar a suffix
▲ 27280 - Arthrodesis, sacroiliac joint, open, includes obtaining bone graft,

including instrumentation, when performed
Surgery Section Changes – Respiratory System
Surgery Section Changes – Respiratory System
Respiratory System :
One new respiratory system code (30469) describes repairing a nasal valve
collapse using temperature-controlled remodeling.
● 30469 - Repair of nasal valve collapse with low energy, temperature-controlled (ie,
radiofrequency) subcutaneous/submucosal remodeling
Surgery Section Changes – Cardiovascular System
Cardiovascular System :
There are seven new codes and one revised code in the cardiovascular section :
● 33900 - Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections,
unilateral
● 33901 - Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections,
bilateral
● 33902 - Percutaneous pulmonary artery revascularization by stent placement, initial; abnormal connections,
unilateral
● 33903 - Percutaneous pulmonary artery revascularization by stent placement, initial; abnormal connections, bilateral
● +33904 - Percutaneous pulmonary artery revascularization by stent placement, each additional vessel or separate
lesion, normal or abnormal connections (List separately in addition to code for primary procedure)
Normal native connections exist when the pathway of blood flow follows the
expected course through the right and left heart chambers and great vessels (ie,
superior vena cava/inferior vena cava to right atrium, then right ventricle, then
pulmonary arteries for the right heart; left atrium to left ventricle, then aorta for the
left heart).
Examples of congenital heart defects with normal connections would include

acyanotic defects such as isolated atrial septal defect, ventricular septal defect, or
patent ductus arteriosus.
Abnormal native connections exist when there are alternative connections for the
pathway of blood flow through the heart and great vessels.
Abnormal connections are typically present in patients with cyanotic congenital heart
defects, any variation of single ventricle anatomy (e.g, hypoplastic right or left heart, double
outlet right ventricle), unbalanced atrioventricular canal (endocardial cushion) defect,
transposition of the great arteries, valvular atresia, tetralogy of Fallot with or without major
aortopulmonary collateral arteries (MAPCAs), total anomalous pulmonary veins, truncus
arteriosus, and any lesions with heterotaxia and/or dextrocardiaed atrial septal defect,
ventricular septal defect, or patent ductus arteriosus.
● 36836 - Percutaneous arteriovenous fistula creation, upper extremity, single access of both the
peripheral artery and peripheral vein, including fistula maturation procedures (eg, transluminal
balloon angioplasty, coil embolization) when performed, including all vascular access, imaging
guidance and radiologic supervision and interpretation
● 36837 - Percutaneous arteriovenous fistula creation, upper extremity, separate access sites of the
peripheral artery and peripheral vein, including fistula maturation procedures (eg, transluminal
balloon angioplasty, coil embolization) when performed, including all vascular access, imaging
guidance and radiologic supervision and interpretation
▲ 35883 - Revision, femoral anastomosis of synthetic arterial bypass graft in groin,

open; with nonautogenous patch graft (eg, polyester, ePTFE, bovine pericardium)
Surgery Section Changes – Digestive System
The digestive system section includes 17 new codes and 18 deletions:
● 43290 - Esophagogastroduodenoscopy, flexible, transoral; with deployment of

intragastric bariatric balloon
● 43291 - Esophagogastroduodenoscopy, flexible, transoral; with removal of

intragastric bariatric balloon(s)
Digestive System :
• There are extensive changes to the hernia repair codes for abdominal hernias
which include epigastric, incisional, ventral, umbilical and spigelian hernias.
• 18 codes were deleted and replaced with 15 new codes.
• The new code family includes any approach and include mesh implantation.
● 49591 - Repair of anterior abdominal hernia(s) (i.e, epigastric, incisional, ventral,
umbilical, spigelian), any approach (i.e, open, laparoscopic, robotic), initial,
including implantation of mesh or other prosthesis when performed, total length of
defect(s); less than 3 cm, reducible
● 49592 - Repair of anterior abdominal hernia(s) (i.e, epigastric, incisional, ventral,

umbilical, spigelian), any approach (i.e, open, laparoscopic, robotic), initial,
including implantation of mesh or other prosthesis when performed, total length of
defect(s); less than 3 cm, incarcerated or strangulated
● 49593 - Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical,
spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or
other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, reducible
other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, incarcerated or
strangulated
other prosthesis when performed, total length of defect(s); greater than 10 cm, reducible
● 49596 - Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any
approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when
performed, total length of defect(s); greater than 10 cm, incarcerated or strangulated
approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when
performed, total length of defect(s); less than 3 cm, reducible
approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when
performed, total length of defect(s); less than 3 cm, incarcerated or strangulated
spigelian), any approach (i.e, open, laparoscopic, robotic), recurrent, including implantation of mesh
or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, reducible
or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, incarcerated or
strangulated
● 49617- Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical,
or other prosthesis when performed, total length of defect(s); greater than 10 cm, reducible
spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation
of mesh or other prosthesis when performed, total length of defect(s); greater than 10 cm,
incarcerated or strangulated
● 49621 - Repair of parastomal hernia, any approach (ie, open, laparoscopic, robotic), initial
or recurrent, including implantation of mesh or other prosthesis, when performed; reducible
● 49622 - Repair of parastomal hernia, any approach (ie, open, laparoscopic, robotic), initial
or recurrent, including implantation of mesh or other prosthesis, when performed;
incarcerated or strangulated
● + 49623 - Removal of total or near total non-infected mesh or other prosthesis at
the time of initial or recurrent anterior abdominal hernia repair or parastomal hernia
repair, any approach (ie, open, laparoscopic, robotic)
Add on code 49623 can be reported only with codes 49591-49622.

Del
49560 - Repair initial incisional or ventral hernia; reducible
49561 - Repair initial incisional or ventral hernia; incarcerated or strangulated
49565 - Repair recurrent incisional or ventral hernia; reducible
49566 - Repair recurrent incisional or ventral hernia; incarcerated or strangulated
49568 - Implantation of mesh or other prosthesis for open incisional or ventral
hernia repair or mesh for closure of debridement for necrotizing soft tissue infection
49570 - Repair epigastric hernia (eg, preperitoneal fat); reducible (separate
procedure)
Del
49572 - Repair epigastric hernia (eg, preperitoneal fat); incarcerated or strangulated
49580 - Repair umbilical hernia, younger than age 5 years; reducible
49582 - Repair umbilical hernia, younger than age 5 years; incarcerated or strangulated
49585 - Repair umbilical hernia, age 5 years or older; reducible
49587 - Repair umbilical hernia, age 5 years or older; incarcerated or strangulated

49590 - Repair spigelian hernia
49652 - Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia
(includes mesh insertion, when performed); reducible
Del
49653 - Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia
(includes mesh insertion, when performed); incarcerated or strangulated
49654 - Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when
performed); reducible
49655 - Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when
performed); incarcerated or strangulated
49656 - Laparoscopy, surgical, repair, recurrent incisional hernia

(includes mesh insertion, when performed); reducible
49657 - Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion,
when performed); incarcerated or strangulated
Surgery Section Changes – Urinary System
Urinary system codes 50080 and 50081 have been revised in this section to include
more detail to clarify which services are included in percutaneous nephrolithotomy
or pyelolithotomy lithotripsy procedure.
▲ 50080 - Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone

extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy
tube placement, when performed, including imaging guidance; simple (eg, stone[s]
up to 2 cm in single location of kidney or renal pelvis, nonbranching stones)
▲ 50081 - Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone

extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy
tube placement, when performed, including imaging guidance; complex (eg,
stone[s] > 2 cm, branching stones, stones in multiple locations, ureter stones,
complicated anatomy)
Surgery Section Changes – Male Reproductive System
Surgery Section Changes – Male Reproductive System
One new code (55867) has been added to the male genital system section to
describe a laparoscopic simple subtotal prostatectomy, including robotic assistance
when used.
● 55867 - Laparoscopy, surgical prostatectomy, simple subtotal (including control of

postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation,
and internal urethrotomy), includes robotic assistance, when performed
Surgery Section Changes – Nervous System
There are 7 revisions in Nervous system: These codes are revised to include imaging
guidance when performed.
▲ 64415 - Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, including

imaging guidance, when performed
▲ 64416 - Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, continuous

infusion by catheter (including catheter placement), including imaging guidance, when
performed
▲ 64417 - Injection(s), anesthetic agent(s) and/or steroid; axillary nerve, including imaging
guidance, when performed
Brachial Plexus
▲ 64445 - Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, including imaging guidance,
when performed
▲ 64446 - Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, continuous infusion by
catheter (including catheter placement), including imaging guidance, when performed
▲ 64447 - Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, including imaging
guidance, when performed
▲ 64448 - Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, continuous infusion by
catheter (including catheter placement), including imaging guidance, when performed
Surgery Section Changes – Eye & Ocular Adnexa
Surgery Section Changes - Eye and Ocular Adnexa
There are two revisions in Transluminal dilation of aqueous outflow canal
▲ 66174 - Transluminal dilation of aqueous outflow canal (e.g, canaloplasty);

without retention of device or stent
▲ 66175 - Transluminal dilation of aqueous outflow canal (e.g, canaloplasty); with

retention of device or stent
Surgery Section Changes - Auditory System
Three new codes (69728–69730) describing the removal, implantation, and replacement of an
osseointegrated skull implant were added to the auditory system section, plus five revisions:
● 69728 - Removal, entire osseointegrated implant, skull; with magnetic transcutaneous attachment
to external speech processor, outside the mastoid and involving a bony defect greater than or equal
to 100 sq mm surface area of bone deep to the outer cranial cortex
● 69729 - Implantation, osseointegrated implant, skull; with magnetic transcutaneous attachment to

external speech processor, outside of the mastoid and resulting in removal of greater than or equal
to 100 sq mm surface area of bone deep to the outer cranial cortex
Auditory Osseointegrated Implants (AOI) :
Coding Tip :
To report mastoidectomy performed at the same operative session as osseointegrated implant placement,
revision, replacement, or removal, see 69501-69676. In addition to mastoidectomies, other reparative
middle ear and mastoid procedures in 69501-69676 may be performed for different indications and may
also be reported separately.
● 69730 - Replacement (including removal of existing device), osseointegrated implant, skull; with
magnetic transcutaneous attachment to external speech processor, outside the mastoid and involving a
bony defect greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex
▲ 69716 - Implantation, osseointegrated implant, skull; with magnetic
transcutaneous attachment to external speech processor, within the mastoid and/or
resulting in removal of less than 100 sq mm surface area of bone deep to the outer
cranial cortex
▲ 69717 - Replacement (including removal of existing device), osseointegrated

implant, skull; with percutaneous attachment to external speech processor
▲ 69719 - Replacement (including removal of existing device), osseointegrated

implant, skull; with magnetic transcutaneous attachment to external speech
processor, within the mastoid and/or involving a bony defect less than 100 sq mm
surface area of bone deep to the outer cranial cortex
▲ 69726 - Removal, entire osseointegrated implant, skull; with percutaneous
attachment to external speech processor
▲ 69727 - Removal, entire osseointegrated implant, skull; with magnetic

transcutaneous attachment to external speech processor, within the mastoid and/or
involving a bony defect less than 100 sq mm surface area of bone deep to the outer
cranial cortex
Radiology Section Changes
The Radiology section gained one code (76883), which describes an ultrasound of
the nerves and accompanying structures throughout the entire anatomic course in
one extremity.
● 76883 - Ultrasound, nerve(s) and accompanying structures throughout their entire

anatomic course in one extremity, comprehensive, including real-time cine imaging
with image documentation, per extremity
Five codes (76882,78803, and 78830 –78832) have been revised in this section to include
clarifying words to the long descriptors.
▲ 76882 - Ultrasound, limited, joint or focal evaluation of other nonvascular extremity

structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft-tissue
structure[s], or soft-tissue mass[es]), real-time with image documentation
▲ 78803 - Radiopharmaceutical localization of tumor, inflammatory process or distribution

of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when
performed); tomographic (SPECT), single area (eg, head, neck, chest, pelvis) or
acquisition, single day imaging
▲ 78830 - Radiopharmaceutical localization of tumor, inflammatory process or distribution of
radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed);
tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for
anatomical review, localization and determination/detection of pathology, single area (eg, head, neck,
chest, pelvis) or acquisition, single day imaging
▲ 78831 - Radiopharmaceutical localization of tumor, inflammatory process or distribution of

radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed);
tomographic (SPECT), minimum 2 areas (eg, pelvis and knees, chest and abdomen) or separate
acquisitions (eg, lung ventilation and perfusion), single day imaging, or single area or acquisition
over 2 or more days
▲ 78832 - Radiopharmaceutical localization of tumor, inflammatory process or
distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool
imaging, when performed); tomographic (SPECT) with concurrently acquired
computed tomography (CT) transmission scan for anatomical review, localization
and determination/detection of pathology, minimum 2 areas (eg, pelvis and knees,
chest and abdomen) or separate acquisitions (eg, lung ventilation and perfusion),
single day imaging, or single area or acquisition over 2 or more days
Pathology and Laboratory Section Changes
There are 11 new codes and three revisions in the pathology and laboratory section:
 Three new codes (81449, 81451, and 81456) describe targeted genomic sequence analyses.
 Four new codes (87468, 87469, 87478, 87484) describe various infectious agent detections using
DNA or RNA.
 One new code (81418) has been added for drug metabolism analysis using a genomic sequence.
 Another new code (81441) describes the detection of inherited bone marrow failure syndromes
(IBMFS).
 Code 84433 describes the detection of an enzyme called thiopurine S-methyltransferase (TPMT).
 Code 87467 describes the detection of the hepatitis B surface antigen.
● 81418 - Drug metabolism (eg, pharmacogenomics) genomic sequence analysis
panel, must include testing of at least 6 genes, including CYP2C19, CYP2D6, and
CYP2D6 duplication/deletion analysis
● 81441 - Inherited bone marrow failure syndromes (IBMFS) (eg, Fanconi anemia,
dyskeratosis congenita, Diamond-Blackfan anemia, Shwachman-Diamond
syndrome, GATA2 deficiency syndrome, congenital amegakaryocytic
thrombocytopenia) sequence analysis panel, must include sequencing of at least 30
genes, including BRCA2, BRIP1, DKC1, FANCA, FANCB, FANCC, FANCD2,
FANCE, FANCF, FANCG, FANCI, FANCL, GATA1, GATA2, MPL, NHP2, NOP10,
PALB2, RAD51C, RPL11, RPL35A, RPL5, RPS10, RPS19, RPS24, RPS26, RPS7,
SBDS, TERT, and TINF2
● 81449 - Targeted genomic sequence analysis panel, solid organ neoplasm, 5-50
genes (eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, MET, NRAS,
PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence
variants and copy number variants or rearrangements, if performed; RNA analysis
● 81451 - Targeted genomic sequence analysis panel, hematolymphoid neoplasm

or disorder, 5-50 genes (eg, BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2,
JAK2, KIT, KRAS, MLL, NOTCH1, NPM1, NRAS), interrogation for sequence
variants, and copy number variants or rearrangements, or isoform expression or
mRNA expression levels, if performed; RNA analysis
● 81456 - Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm or disorder, 51 or
greater genes (eg, ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT,
KRAS, MET, MLL, NOTCH1, NPM1, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for
sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if
performed; RNA analysis
● 84433 - Thiopurine S-methyltransferase (TPMT)
● 87467 - Hepatitis B surface antigen (HBsAg), quantitative
● 87468 - Infectious agent detection by nucleic acid (DNA or RNA); Anaplasma phagocytophilum, amplified probe
technique
● 87469 - Infectious agent detection by nucleic acid (DNA or RNA); Babesia microti, amplified probe technique
● 87478 - Infectious agent detection by nucleic acid (DNA or RNA); Borrelia miyamotoi, amplified probe technique
● 87484 - Infectious agent detection by nucleic acid (DNA or RNA); Ehrlichia chaffeensis, amplified probe technique
Three codes were revised in this section (81445, 81450, and 81455) to move the
placement of some of the examples and descriptive wording within the descriptors, but the
overall meaning of the descriptor did not change.
▲ 81445 - Targeted genomic sequence analysis panel, solid organ neoplasm, 5-50 genes
(eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, MET, NRAS, PDGFRA, PDGFRB,
PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants
or rearrangements, if performed; DNA analysis or combined DNA and RNA analysis
▲ 81450 - Targeted genomic sequence analysis panel, hematolymphoid neoplasm or

disorder, 5-50 genes (eg, BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2, JAK2, KIT,
KRAS, MLL, NOTCH1, NPM1, NRAS), interrogation for sequence variants, and copy
number variants or rearrangements, or isoform expression or mRNA expression levels, if
performed; DNA analysis or combined DNA and RNA analysis
▲ 81455 - Targeted genomic sequence analysis panel, solid organ or
hematolymphoid neoplasm or disorder, 51 or greater genes (eg, ALK, BRAF,
CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT,
KRAS, MET, MLL, NOTCH1, NPM1, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA,
PTEN, RET), interrogation for sequence variants and copy number variants or
rearrangements, or isoform expression or mRNA expression levels, if performed;
DNA analysis or combined DNA and RNA analysis
Medicine Section Changes
Ten new codes have been added to the medicine section:
 Three new codes (93569 and 93573–93575) are add-on codes describing
injection procedures for angiographies during cardiac catheterizations.
 New codes 96202 and 96203 are for multiple-family group behavior
management/modification training for parent(s)/guardian(s)/caregiver(s) of
patients with a mental or physical health diagnosis.
 Additional new codes describe the respiratory syncytial vaccine (90678),
orthoptic training (92066), quantitative pupillometry (95919), and remote
therapeutic monitoring for cognitive behavioral therapy (98978).
Codes for COVID-19 vaccines are released for early use based on the public
health emergency.
The vaccine administration codes include the type of vaccine and the number of
doses.
To properly report COVID-19 vaccines, there is an administration code and a

supply code (if your provider did not receive the supply of the vaccine for free).
Appendix Q is added for coding clarification on the proper use of the COVID-19
vaccine administration and supply codes.
● 90678 - Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use
● 92066 - Orth optic training; under supervision of a physician or other qualified health care
professional
● + 93569 - Injection procedure during cardiac catheterization including imaging
supervision, interpretation, and report; for selective pulmonary arterial angiography,
unilateral (List separately in addition to code for primary procedure)
● + 93573 - Injection procedure during cardiac catheterization including imaging
supervision, interpretation, and report; for selective pulmonary arterial angiography,
bilateral (List separately in addition to code for primary procedure)
● 93574 - Injection procedure during cardiac catheterization including imaging supervision,
interpretation, and report; for selective pulmonary venous angiography of each distinct
pulmonary vein during cardiac catheterization (List separately in addition to code for
primary procedure)
● 93575 - Injection procedure during cardiac catheterization including imaging supervision,
interpretation, and report; for selective pulmonary angiography of major aortopulmonary collateral
arteries (MAPCAs) arising off the aorta or its systemic branches, during cardiac catheterization for
congenital heart defects, each distinct vessel (List separately in addition to code for primary
procedure)
● 95919- Quantitative pupillometry with physician or other qualified health care professional
interpretation and report, unilateral or bilateral
● 96202- Multiple-family group behavior management/modification training for

parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis,
administered by physician or other qualified health care professional (without the patient present),
face-to-face with multiple sets of parent(s)/guardian(s)/caregiver(s); initial 60 minutes
● 96203 - Multiple-family group behavior management/modification training for
parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis,
administered by physician or other qualified health care professional (without the patient present),
face-to-face with multiple sets of parent(s)/guardian(s)/caregiver(s); each additional 15 minutes (List
separately in addition to code for primary service)
● 98978 - Remote therapeutic monitoring (eg, therapy adherence, therapy response); device(s)
supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor
cognitive behavioral therapy, each 30 days
● 99418 - Prolonged inpatient or observation evaluation and management service(s) time with or
without direct patient contact beyond the required time of the primary service when the primary
service level has been selected using total time, each 15 minutes of total time (List separately in
addition to the code of the inpatient and observation Evaluation and Management service)
The Medicine section also includes seven revisions:
 Code 92065 now includes wording stating that a physician or other qualified
healthcare professional should perform the orthoptic training.
 Code 92229 replaces “automated analysis” with “autonomous analysis” when

referring to a retina imaging report.
 Code 92284 has been revised to clarify that it’s a diagnostic examination.
 Clarifying words have been added to add-on code 93568 to describe an injection
procedure during cardiac catheterization.
 Finally, codes 98975–98977 have been revised to remove some previously listed
examples.
▲ 92065 - Orthoptic training; performed by a physician or other qualified health
care professional
▲ 92229 - Imaging of retina for detection or monitoring of disease; point-of-care

autonomous analysis and report, unilateral or bilateral
▲ 92284 - Diagnostic dark adaptation examination with interpretation and report
▲ 93568 - Injection procedure during cardiac catheterization including imaging

supervision, interpretation, and report; for nonselective pulmonary arterial
angiography (List separately in addition to code for primary procedure)
▲ 98975 - Remote therapeutic monitoring (eg, therapy adherence, therapy
response); initial set-up and patient education on use of equipment

response); device(s) supply with scheduled (eg, daily) recording(s) and/or
programmed alert(s) transmission to monitor respiratory system, each 30 days

response); device(s) supply with scheduled (eg, daily) recording(s) and/or
programmed alert(s) transmission to monitor musculoskeletal system, each 30 days
Category III Section Changes
There are 46 new Category III codes representing a wide variety of new and emerging
services, including the following:
 Treatment planning and ablation of malignant prostate tissue by magnetic

field induction.
 Remote autonomous algorithm-based recommendation system for insulin
dosages.
 Absolute quantitation of myocardial blood flow (AQMBF) using computed
tomography.
 Bone strength/fracture risk analysis and assessment using digital X-ray
radiogrammetry.
 Insertion of a bioprosthetic valve into the femoral vein.
 Cardiac focal ablation utilizing radiation therapy for arrhythmia.
 Injections of stem cell product into perianal perifistular soft tissue
 Digitization of glass microscope slides.
 Assistive algorithmic electrocardiogram risk-based assessment for cardiac
dysfunction.
 Transcutaneous magnetic stimulation by focused low-frequency
electromagnetic pulse of the peripheral nerve.
 Virtual reality technology to assist therapy.
 Arthrodesis of the sacroiliac joint, including the placement of an intra-articular
implant.
 Therapeutic induction of intra-brain hypothermia.
 Real-time pressure-sensing epidural guidance system.
 Surface mechanomyography (sMMG) with concurrent application of inertial

measurement unit (IMU) sensors to measure multi-joint range of motion, posture, gait,
and muscle function.
 Gastrointestinal myoelectrical activity study.
 Installation of fecal microbiota suspension via rectal enema into the lower
gastrointestinal tract.
 Bronchoscopy, rigid or flexible, with insertion of esophageal protection device and

circumferential radiofrequency destruction of the pulmonary nerves.
 Transcutaneous auricular neurostimulation.

● 0738T - Treatment planning for magnetic field induction ablation of malignant prostate tissue, using
data from previously performed magnetic resonance imaging (MRI) examination
● 0739T - Ablation of malignant prostate tissue by magnetic field induction, including all
intraprocedural, transperineal needle/catheter placement for nanoparticle installation and
intraprocedural temperature monitoring, thermal dosimetry, bladder irrigation, and magnetic field
nanoparticle activation
● 0740T - Remote autonomous algorithm-based recommendation system for insulin dose calculation
and titration; initial set-up and patient education
● 0741T - Remote autonomous algorithm-based recommendation system for insulin dose calculation
and titration; provision of software, data collection, transmission, and storage, each 30 days
● 0742T - Absolute quantitation of myocardial blood flow (AQMBF), single-photon emission
computed tomography (SPECT), with exercise or pharmacologic stress, and at rest, when performed
● 0743T - Bone strength and fracture risk using finite element analysis of functional data and bone-
mineral density, with concurrent vertebral fracture assessment, utilizing data from a computed
tomography scan, retrieval and transmission of the scan data, measurement of bone strength and
bone mineral density and classification of any vertebral fractures, with overall fracture risk
assessment, interpretation and report
● 0744T - Insertion of bioprosthetic valve, open, femoral vein, including duplex ultrasound imaging
guidance, when performed, including autogenous or nonautogenous patch graft (eg, polyester,
ePTFE, bovine pericardium), when performed
● 0746T - Cardiac focal ablation utilizing radiation therapy for arrhythmia; conversion of arrhythmia
localization and mapping of arrhythmia site (nidus) into a multidimensional radiation treatment plan
● 0747T - Cardiac focal ablation utilizing radiation therapy for arrhythmia; delivery of radiation
therapy, arrhythmia
● 0748T - Injections of stem cell product into perianal perifistular soft tissue, including fistula
preparation (eg, removal of setons, fistula curettage, closure of internal openings)
● 0749T - Bone strength and fracture-risk assessment using digital X-ray radiogrammetry-bone
mineral density (DXR-BMD) analysis of bone mineral density (BMD) utilizing data from a digital X
ray, retrieval and transmission of digital X ray data, assessment of bone strength and fracture-risk
and BMD, interpretation and report;
● 0750T - Bone strength and fracture-risk assessment using digital X-ray radiogrammetry-bone mineral density
(DXR-BMD) analysis of bone mineral density (BMD) utilizing data from a digital X ray, retrieval and transmission
of digital X ray data, assessment of bone strength and fracture-risk and BMD, interpretation and report; with
single-view digital X-ray examination of the hand taken for the purpose of DXR-BMD
● 0751T - Digitization of glass microscope slides for level II, surgical pathology, gross and microscopic
examination (List separately in addition to code for primary procedure)
● 0752T - Digitization of glass microscope slides for level III, surgical pathology, gross and microscopic
● 0753T - Digitization of glass microscope slides for level IV, surgical pathology, gross and microscopic
● 0754T - Digitization of glass microscope slides for level V, surgical pathology, gross and microscopic
● 0755T - Digitization of glass microscope slide for level VI, surgical pathology, gross and
microscopic examination (List separately in addition to code for primary procedure)
● 0756T - Digitization of glass microscope slides for special stain, including interpretation and report,
group I, for microorganisms (eg, acid fast, methenamine silver) (List separately in addition to code for
primary procedure)
group II, all other (eg, iron, trichrome), except stain for microorganisms, stains for enzyme
constituents, or immunocytochemistry and immunohistochemistry (List separately in addition to code
for primary procedure)
histochemical stain on frozen tissue block (List separately in addition to code for primary procedure)
● 0759T - Digitization of glass microscope slides for special stain, including interpretation
and report, group III, for enzyme constituents (List separately in addition to code for primary
procedure)
● 0760T - Digitization of glass microscope slides for immunohistochemistry or

immunocytochemistry, per specimen, initial single antibody stain procedure (List separately
in addition to code for primary procedure)

immunocytochemistry, per specimen, each additional single antibody stain procedure (List
separately in addition to code for primary procedure)

immunocytochemistry, per specimen, each multiplex antibody stain procedure (List
● 0763T - Digitization of glass microscope slides for morphometric analysis, tumor immunohistochemistry
(e.g, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen,
each single antibody stain procedure, manual
● 0764T - Assistive algorithmic electrocardiogram risk-based assessment for cardiac dysfunction (e.g,
low-ejection fraction, pulmonary hypertension, hypertrophic cardiomyopathy); related to concurrently
performed electrocardiogram (List separately in addition to code for primary procedure)
● 0765T - Assistive algorithmic electrocardiogram risk-based assessment for cardiac dysfunction (eg,
low-ejection fraction, pulmonary hypertension, hypertrophic cardiomyopathy); related to previously
performed electrocardiogram
● 0766T - Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse,
peripheral nerve, initial treatment, with identification and marking of the treatment location, including
noninvasive electroneurographic localization (nerve conduction localization), when performed; first nerve
peripheral nerve, initial treatment, with identification and marking of the treatment location, including
noninvasive electroneurographic localization (nerve conduction localization), when performed; each
additional nerve (List separately in addition to code for primary procedure)

peripheral nerve, subsequent treatment, including noninvasive electroneurographic localization (nerve
conduction localization), when performed; first nerve

peripheral nerve, subsequent treatment, including noninvasive electroneurographic localization (nerve
conduction localization), when performed; each additional nerve (List separately in addition to code for
primary procedure)
● 0770T - Virtual reality technology to assist therapy (List separately in addition to code for primary
procedure)
● 0771T - Virtual reality (VR) procedural dissociation services provided by the same physician or other
qualified health care professional performing the diagnostic or therapeutic service that the VR procedural
dissociation supports, requiring the presence of an independent, trained observer to assist in the
monitoring of the patient's level of dissociation or consciousness and physiological status;
initial 15 minutes of intraservice time, patient age 5 years or older
● 0772T - Virtual reality (VR) procedural dissociation services provided by the same physician or other
qualified health care professional performing the diagnostic or therapeutic service that the VR procedural
dissociation supports, requiring the presence of an independent, trained observer to assist in the
monitoring of the patient's level of dissociation or consciousness and physiological status; each additional
15 minutes intraservice time (List separately in addition to code for primary service)
● 0773T - Virtual reality (VR) procedural dissociation services provided by a physician or other
qualified health care professional other than the physician or other qualified health care professional
performing the diagnostic or therapeutic service that the VR procedural dissociation supports; initial
15 minutes of intraservice time, patient age 5 years or older
● 0774T - Virtual reality (VR) procedural dissociation services provided by a physician or other
qualified health care professional other than the physician or other qualified health care professional
performing the diagnostic or therapeutic service that the VR procedural dissociation supports; each
additional 15 minutes intraservice time (List separately in addition to code for primary service)
● 0775T -Arthrodesis, sacroiliac joint, percutaneous, with image guidance, includes placement of
intra-articular implant(s) (eg, bone allograft[s], synthetic device[s])
● 0776T - Therapeutic induction of intra-brain hypothermia, including placement of a mechanical
temperature-controlled cooling device to the neck over carotids and head, including monitoring (eg,
vital signs and sport concussion assessment tool 5 [SCAT5]), 30 minutes of treatment
● 0777T - Real-time pressure-sensing epidural guidance system (List separately in addition to code
for primary procedure)
● 0778T - Surface mechanomyography (sMMG) with concurrent application of inertial measurement

unit (IMU) sensors for measurement of multi-joint range of motion, posture, gait, and muscle function
● 0779T - Gastrointestinal myoelectrical activity study, stomach through colon, with interpretation and
report
● 0780T - Instillation of fecal microbiota suspension via rectal enema into
lower gastrointestinal tract
● 0781T - Bronchoscopy, rigid or flexible, with insertion of esophageal protection device and
circumferential radiofrequency destruction of the pulmonary nerves, including fluoroscopic
guidance when performed; bilateral mainstem bronchi
● 0782T - Bronchoscopy, rigid or flexible, with insertion of esophageal protection device and
circumferential radiofrequency destruction of the pulmonary nerves, including fluoroscopic
guidance when performed; unilateral mainstem bronchus
● 0783T - Transcutaneous auricular neurostimulation, set-up, calibration, and patient

education on use of equipment
The Category III section has revisions to two remote therapy codes (0733T and
0734T), changing the description of the remote therapy from “body and limb
kinematic measurement based” to “real-time, motion capture-based
neurorehabilitative.”
▲ 0733T - Remote real-time, motion capture-based neurorehabilitative therapy

ordered by a physician or other qualified health care professional; supply and
technical support, per 30 days
▲ 0734T - Remote real-time, motion capture-based neurorehabilitative therapy

ordered by a physician or other qualified health care professional; treatment
management services by a physician or other qualified health care professional, per
calendar month
This update also includes 23 code deletions in Category III, including the following:
 Total disc arthroplasty (artificial disc), anterior approach.

 Vagus nerve-blocking therapy for morbid obesity.
 Optical coherence tomography (OCT) for imaging of the skin.
 Recording of fetal magnetic cardiac signal.
 Biomechanical mapping, transvaginal.
 Ablative laser treatment, non-contact, for an open wound.
 Contact near-infrared spectroscopy studies of lower extremity wounds.
 Electrocardiographic rhythm-derived event recorder without 24-hour attended monitoring.
 Cystourethroscopy with mechanical dilation and urethral therapeutic drug delivery.
 Intraoperative visual axis identification using patient fixation.
 Remote therapeutic monitoring of a standardized online digital cognitive behavioral therapy
program
Del
0163T - Total disc arthroplasty (artificial disc), anterior approach, including discectomy to
prepare interspace (other than for decompression), each additional interspace, lumbar (List
0312T - Vagus nerve blocking therapy (morbid obesity); laparoscopic implantation of

neurostimulator electrode array, anterior and posterior vagal trunks adjacent to
esophagogastric junction (EGJ), with implantation of pulse generator, includes
programming
0313T - Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or

replacement of vagal trunk neurostimulator electrode array, including connection to existing
pulse generator
0314T - Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal
trunk neurostimulator electrode array and pulse generator
Del
0475T - Recording of fetal magnetic cardiac signal using at least 3 channels; patient
recording and storage, data scanning with signal extraction, technical analysis and result,
as well as supervision, review, and interpretation of report by a physician or other qualified
health care professional
0476T - Recording of fetal magnetic cardiac signal using at least 3 channels; patient
recording, data scanning, with raw electronic signal transfer of data and storage
0477T - Recording of fetal magnetic cardiac signal using at least 3 channels; signal
extraction, technical analysis, and result
0478T - Recording of fetal magnetic cardiac signal using at least 3 channels; review,
interpretation, report by physician or other qualified health care professional
Del
0487T - Biomechanical mapping, transvaginal, with report
0491T - Ablative laser treatment, non-contact, full field and fractional ablation, open
wound, per day, total treatment surface area; first 20 sq cm or less
0492T - Ablative laser treatment, non-contact, full field and fractional ablation, open
wound, per day, total treatment surface area; each additional 20 sq cm, or part
thereof (List separately in addition to code for primary procedure)
0493T - Contact near-infrared spectroscopy studies of lower extremity wounds (eg,

for oxyhemoglobin measurement)
Del
0497T - External patient-activated, physician- or other qualified health care
professional-prescribed, electrocardiographic rhythm derived event recorder without
24-hour attended monitoring; in-office connection
0498T - External patient-activated, physician- or other qualified health care

professional-prescribed, electrocardiographic rhythm derived event recorder without
24-hour attended monitoring; review and interpretation by a physician or other
qualified health care professional per 30 days with at least one patient-generated
triggered event
0499T - Cystourethroscopy, with mechanical dilation and urethral therapeutic drug

delivery for urethral stricture or stenosis, including fluoroscopy, when performed
Del
0514T - Intraoperative visual axis identification using patient fixation (List
0702T - Remote therapeutic monitoring of a standardized online digital cognitive

behavioral therapy program ordered by a physician or other qualified health care
professional; supply and technical support, per 30 days
0703T - Remote therapeutic monitoring of a standardized online digital cognitive

behavioral therapy program ordered by a physician or other qualified health care
professional; management services by physician or other qualified health care
professional, per calendar month
Knowledge Check 1:
1.Which documentation guidelines should you use to level E/M services in 2023?
A. CMS 1995 Documentation Guidelines
B. CMS 1997 Documentation Guidelines
C. CPT® 2021 Documentation Guidelines
D. CPT® 2023 Documentation Guidelines

Knowledge Check 2 :
2. In 2023, a surgeon removes sutures from a patient while the patient is under
anesthesia. How is this coded?
A. 15850
B. 15851
C. 15853
D. 15854
Knowledge Check 3 :
3. In 2023, how do you code an initial percutaneous pulmonary artery
revascularization by stent placement performed unilaterally in normal native
connections?
A. 33900
B. 33901
C. 33902
D. 33904
Knowledge Check 4 :
4. In 2023, how do you code an initial percutaneous pulmonary artery
revascularization by stent placement performed unilaterally in normal native
connections?
A. 33900
B. 33901
C. 33902
D. 33904
Knowledge Check 5 :
5. The surgeon performs an initial repair of a patient’s spigelian hernia. The date of
service is Jan. 5, 2023. How is the procedure coded?
A. 49590
B. 49591
C. 49613
D. 49623

2023 CPT Coding Changes

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2023 CPT Coding Changes

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2023 CPT® Coding Updates

Anitha Jayaseelan CPC, CIRCC

CPT® Section wise detailed changes for 2023

Revised codes and Revised descriptions

Deleted codes of 2023 and their Replacement codes

New codes added for 2023

Coding guidelines for New & Revised code

Eye and Pathology

 Hospital Observation Services E/M codes 99217-99220 are deleted.

 Consultations E/M codes 99241 and 99251 are deleted

 Nursing Facility Services E/M code 99318 is deleted

 Home or Residence Services E/M code 99343 is deleted

 Prolonged Services E/M codes 99354-99357 are deleted

 Prolonged Services E/M code 99417 and guidelines are revised

 New add-on code for Prolonged Services 99418

● 15778 - Implantation of absorbable mesh or other prosthesis for delayed closure

● +15853 Removal of sutures or staples not requiring anesthesia

(List separately in addition to E/M code)

● + 15854 Removal of sutures and staples not requiring anesthesia

(List separately in addition to E/M code)

▲15851 - Removal of sutures or staples requiring anesthesia

(ie, general anesthesia, moderate sedation)

● +22860 - Total disc arthroplasty (artificial disc), anterior approach, including

▲ 27280 - Arthrodesis, sacroiliac joint, open, includes obtaining bone graft,

Examples of congenital heart defects with normal connections would include

▲ 35883 - Revision, femoral anastomosis of synthetic arterial bypass graft in groin,

● 43290 - Esophagogastroduodenoscopy, flexible, transoral; with deployment of

● 43291 - Esophagogastroduodenoscopy, flexible, transoral; with removal of

• 18 codes were deleted and replaced with 15 new codes.

● 49592 - Repair of anterior abdominal hernia(s) (i.e, epigastric, incisional, ventral,

repair, any approach (ie, open, laparoscopic, robotic)

(List separately in addition to code for primary procedure)

Add on code 49623 can be reported only with codes 49591-49622.

49580 - Repair umbilical hernia, younger than age 5 years; reducible

49585 - Repair umbilical hernia, age 5 years or older; reducible

49587 - Repair umbilical hernia, age 5 years or older; incarcerated or strangulated

49656 - Laparoscopy, surgical, repair, recurrent incisional hernia

▲ 50080 - Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone

▲ 50081 - Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone

● 55867 - Laparoscopy, surgical prostatectomy, simple subtotal (including control of

▲ 64415 - Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, including

▲ 64416 - Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, continuous

▲ 66174 - Transluminal dilation of aqueous outflow canal (e.g, canaloplasty);

▲ 66175 - Transluminal dilation of aqueous outflow canal (e.g, canaloplasty); with

● 69729 - Implantation, osseointegrated implant, skull; with magnetic transcutaneous attachment to

▲ 69717 - Replacement (including removal of existing device), osseointegrated

▲ 69719 - Replacement (including removal of existing device), osseointegrated

▲ 69727 - Removal, entire osseointegrated implant, skull; with magnetic

● 76883 - Ultrasound, nerve(s) and accompanying structures throughout their entire

▲ 76882 - Ultrasound, limited, joint or focal evaluation of other nonvascular extremity

▲ 78803 - Radiopharmaceutical localization of tumor, inflammatory process or distribution

▲ 78831 - Radiopharmaceutical localization of tumor, inflammatory process or distribution of

● 81451 - Targeted genomic sequence analysis panel, hematolymphoid neoplasm

● 84433 - Thiopurine S-methyltransferase (TPMT)

● 87467 - Hepatitis B surface antigen (HBsAg), quantitative

▲ 81450 - Targeted genomic sequence analysis panel, hematolymphoid neoplasm or

To properly report COVID-19 vaccines, there is an administration code and a

● 96202- Multiple-family group behavior management/modification training for

 Code 92229 replaces “automated analysis” with “autonomous analysis” when

▲ 92229 - Imaging of retina for detection or monitoring of disease; point-of-care