EM Coding Alert

Don't miss: CPT^® 2018 to delete anticoagulant codes 99363 and 99364.

From behavioral health and psychiatric care management codes, to new anticoagulant options, to an evaluation and management (E/M) observation care language revision, the 2018 CPT^® changes are headed your way. Read on to see how these changes, effective as of January 1, 2018, will impact your practice.

Write Down These Behavioral Health, Psychiatric Care Management Codes

As you're going through the CPT^® 2018 codes, don't miss these new behavioral health and psychiatric care management options.

Additions:

• 99483 (Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home ...)
• 99484 (Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month ...)
• 99492 (Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional ...)
• 99493 (Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional...)
• +99494 (Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional [List separately in addition to code for primary procedure]).

Caution: Codes 99492, 99493, and +99494 all specify that when reporting, you must make sure the psychiatric collaborative care management was performed "in consultation with a psychiatric consultant and directed by the treating physician."

"This should be evident within the medical record documentation of the clinical staff or physician as applicable," emphasizes Suzan Hauptman, MPM, CPC, CEMC, CEDC AAPC fellow, senior principal of ACE Med Group in Pittsburgh.

Editor's note: All of the new care management codes have required components that must be included if you are going to report the code correctly. Stay tuned next month as we dig into exactly what you need to know about these specific requirements.

Catch This Hospital Observation Care Language Change

You'll notice a small language change for the hospital observation codes 99217 and 99218-99220 for CPT^® 2018. All of the descriptors will add the phrase "outpatient hospital."

Hauptman indicates that this change further clarifies where the services should be rendered as they related to these code choices. Observing a patient can be accomplished in both an inpatient setting as well as an outpatient setting; it is dependent on the patient's condition. These codes are only to be used when the patient is admitted as an observation patient.

Revisions: For example, take a look at 99217 (emphasis added):

• 99217 (Observation care discharge day management [This code is to be utilized to report all services provided to a patient on discharge from outpatient hospital "observation status" if the discharge is on other than the initial date of "observation status." ...)

This change also holds true for initial hospital observation care services 99218 (Initial observation care, per day, for the evaluation and management of a patient ... Usually, the problem[s] requiring admission to outpatient hospital "observation status" are of low severity. Typically, 30 minutes are spent at the bedside and on the patient's hospital floor or unit.) through 99220 (... Usually, the problem[s] requiring admission to outpatient hospital "observation status" are of high severity. Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit).

Note: The same phrase "outpatient hospital" will be added to 99217 and 99218 through 99220. However, for 99218 through 99220, according to the code descriptors, this service is an admission to outpatient hospital observation status. On the other hand, with 99217, the service is a discharge from the outpatient hospital observation status.

CPT^® 2018 Strikes Out 99363 and 99364

Deletions: CPT^® 2018 will delete anticoagulant codes 99363 (Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of International Normalized Ratio [INR] testing, patient instructions, dosage adjustment [as needed], and ordering of additional tests; initial 90 days of therapy [must include a minimum of 8 INR measurements]) and 99364 (... each subsequent 90 days of therapy [must include a minimum of 3 INR measurements]) from the E/M section.

Additions: CPT^® 2018 will add new codes 93792 (Patient/caregiver training for initiation of home international normalized ratio [INR] monitoring under the direction of a physician or other qualified health care professional ...) and 93793 (Anticoagulant management for a patient taking warfarin, must include review and interpretation of a new home, office, or lab international normalized ratio [INR] test result, patient instructions, dosage adjustment [as needed], and scheduling of additional test[s], when performed) to the cardiovascular section.

"This change helps to better understand the type of service that is being provided," Hauptman says. "Checking a patient's lab results around their INR and adjusting the medication may not require a face-to-face service or the attention of the physician; both two components of most all E/M services."

"Assigning this type of service a code in the medicine section allows the service to be more accurately represented," Hauptman adds.