General Surgery Coding Alert

Make sure time is on your side.

You just might need to revamp your templates or other time-related reporting procedures before Jan. 1 if you want to capture all the pay you deserve for certain E/M services in the new year.

Help is on the way: Here’s a rundown of CPT^® 2020 E/M code changes along with some expert commentary to ensure you’re up to date when you report these services for your general surgery practice.

Say Goodbye to 99444

The latest round of CPT^® revisions eliminates many of the restrictions to virtual E/M services by deleting the existing code and replacing it with three new time-based codes.

CPT^® 2020 deletes 99444 (Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network).

Recall: This code defines the following parameters for reporting the service:

• Must be for an established patient (or guardian)
• Must be by a physician or other qualified health care professional (QHP)
• Must be unrelated to an E/M service provided within the previous seven days

New code: Greet 99421 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes) for reporting these services starting Jan. 1.

Longer: For more time than 10 minutes, CPT^® 2020 adds the following two new codes:

• 99422 (… 11-20 minutes)
• 99423 (… 21 or more minutes).

Caution: The same restrictions that guide your 99444 use will apply to how you use 99421-99423 in the new year. Most importantly, you cannot use these codes for any online digital E/M service that is the result of a previous visit or that results in a subsequent E/M visit. Instead, you should incorporate that service into the related E/M visit.

Plus: CPT^® 2020 places a seven-day cumulative time limitation on 99421-99423 and makes the codes time-dependent. You will be able to use 99421 if your provider spends between five and 10 minutes on the asynchronous communication with the patient during the seven days, 99423 for 11-20 minutes, and 99423 for 21 or more minutes.

Brush up: Losing 99444 and gaining 99421-99423 presents a teachable moment. “Coders will need to work with their providers to ensure that they are documenting the time factors of the new codes,” advises Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California. “The time component was not required for 99444, so this will be an opportunity for education,” Johnson adds.

Advantage: The good news about the change is that “it compensates the provider for any significant additional time in a seven-day period,” says Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania. However, “practices should review their local Medicare Fiscal Intermediaries’ and Medicare Administrative Contractors’ [FIs’/MACs’] policies on these non-face-to-face services,” Falbo cautions.

Update RPM Coding

CPT^® 2020 also updates coding for remote physiologic monitoring (RPM), which your surgeons might use for cases such as partial colon resection surgery. This revision is a simple change in the parent code’s time parameters, resulting in the change of the descriptor for 99457:

•  From: Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month
• To: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes.

More time: The 99457 code revision opens the door to reporting additional 20-minute increments of your provider’s RPM service time with new code +99458 (… each additional 20 minutes (List separately in addition to code for primary procedure)).

Like the changes to the virtual E/M codes, “this change presents a similar opportunity for coders to educate their providers, as the time components to 99457 and +99458 mean that the provider will have to be specific in their documentation compared to the previous requirement of noting ‘more than 20 minutes,’” says Johnson.

But “the additional time allowed by this code should not only prove particularly beneficial for patients requiring significant monitoring and interaction during a particular month, but also allow your provider to capture the additional work spent on those patients” Falbo adds.

Capture Self-Measure Blood Pressure Monitoring, Too

You’ll find the following two brand-new self-measured blood pressure (SMBP) codes in CPT^® 2020:

• 99473 (Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration)
• 99474 (… separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care profes­sional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient).

Bottom line: These codes, along with the 99421-99423 and 99457-+99458 code changes, reflect “this year’s important additions to CPT^®.” They came about because of “novel digital communication tools, such as patient portals, that allow health care professionals to more efficiently connect with patients at home and exchange information,” according to the AMA press release regarding CPT® 2020.