EM Coding Alert

With everything going on at the moment, there’s a good chance you may have missed the CPT^® 2020 Errata and Technical Corrections that the American Medical Association (AMA) announced on March 2, 2020.

But don’t worry – we’ve got your back. Here are all the E/M code changes you need to know about.

Dial Into 99457, 99458 Guidelines Revisions

You will see some corrections to the CPT^® guidelines for 99457 (Remote physiologic monitoring treatment management services …; first 20 minutes) and new code +99458 (… each additional 20 minutes (List separately in addition to code for primary procedure)).

Take a look at the changes (emphasis added): “For the first completed 20 minutes of clinical staff/physician/ other qualified health care professional time in a calendar month report 99457, and report 99458 for each additional completed 20 minutes,” per the guidelines. “Do not report 99457, 99458 for services of less than 20 minutes. Report 99457 one time regardless of the number of physiologic monitoring modalities performed in a given calendar month.”

Bottom line: The AMA has revised the “Remote Physiologic Monitoring and Treatment Management Services” guidelines to specify that you should report 99457 for the first completed 20 minutes of clinical staff/ physician/ other qualified health care professional time in a calendar month. Also, you should report +99458 for each additional completed 20 minutes, per the revisions.

Code +99458: You will also see some revisions to the parenthetical notes for new code +99458. For example, the second parenthetical note has been completely deleted: (Report only 99457 if you have not completed 20 minutes of additional treatment regardless of time spent).

The AMA has also revised the third parenthetical note for +99458. Now the guidelines specify that you cannot report +99458 for “services of less than an additional increment of 20 minutes” (emphasis added). This revision clarifies how important it is to document the exact time when reporting 99457 and +99458.

You should report 99457 for the first 20 minutes of remote physiologic monitoring treatment management services. When reporting +99458, you must check the documentation to make sure that the provider performed an additional 20 minutes of this service. Code +99458 is an add-on code, so you must always report it in conjunction with primary code 99457, which explains how the words “an additional increment” add clarity to this reporting rule.

Add-on codes: You should never report an add-on code like +99458 as the primary code for a procedure on your claims. Add-on codes are always reported with an appropriate primary code. Add-on codes are identified with the special symbol “+.”

“This is a feature of add-on codes that some people forget,” says Gregory Przybylski, MD at the JFK Medical Center in Edison, New Jersey. “One cannot report an add-on code unless the valid primary code (to which the add-on code is associated with) is also reported. CPT^® lists the specific primary codes to which add-on codes may be used if that service is performed.”

Observe Descriptor Changes to New Codes

The AMA has also changed the descriptors for new codes 98970-98971, removing “evaluation and management service” and adding “assessment and management” instead. So, the code now reads “Qualified nonphysician health care professional online digital evaluation and management service assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes” (emphasis added).

(For the full list of the most recent CPT^® changes, go to: www.ama-assn.org/system/files/2020-03/cpt-corrections-errata-2020.pdf. All changes are effective Jan. 1, 2020).