General Surgery Coding Alert

Follow proposed Physician Fee Schedule insights for these services.

You should expect expanded coverage for telehealth services in 2018 - that's the word on the street based on the recent Medicare Physician Fee Schedule (MPFS) proposed rule.

Get up to speed: For calendar year (CY) 2017, CMS invested in telehealth with codes for advanced care planning, critical care consultation, and End-Stage Renal Disease (ESRD)-related services for dialysis. Here is an overview of what CPT^® and HCPCS Level II codes your general surgery practice could be reporting for telehealth services now:

• 99497 (Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified healthcare professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate)
• +99498 (... each additional 30 minutes (List separately in addition to code for primary procedure))
• G0508 (Telehealth consultation, critical care, initial, physicians typically spend 60 minutes communicating with the patient and providers via telehealth)
• G0509 (... subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth)
• 90967 (End-stage renal disease [ESRD] related services for dialysis less than a full month of service, per day; for patients younger than 2 years of age).

Prepare for CY 2018 Proposed Updates

CMS continues its support of this important care option in the CY 2018 proposed rule, with a selection of diverse codes supporting chronic care management, and behavioral health, as well as a suggestion that it might do away with a particularly frustrating modifier requirement.

"CMS has again proposed to expand the list of covered telehealth services, including adding coverage for Health Risk Assessments, care planning for chronic care management, and psychotherapy for crisis services provided via telehealth," notes attorney Benjamin Fee, Esq., of Dorsey and Whitney LLP in Des Moines, Iowa.

Here are the specifics that CMS mentioned in the proposed MPFS for CY 2018 fact sheet that might impact your general surgery practice:

• +90785 (Interactive complexity (List separately in addition to the code for primary procedure))
• 96160 and 96161 (Administration of ... health risk assessment instrument ... with scoring and documentation, per standardized instrument)
• G0506 (Comprehensive assessment of and care planning for patients requiring chronic care management services (List separately in addition to primary monthly care management service))
• G0296 (Counseling visit to discuss need for lung cancer screening using low dose CT scan (service is for eligibility determination and shared decision making)).

Modifier change: The updates also push to drop the need for the "telehealth modifier for professional claims" starting in 2018. "Anytime a billing requirement is removed, it is positive - one less regulation to potentially 'trip over,'" says Vinod Gidwani, founder and president of Currence Inc. in Skokie, Ill. "Telemedicine will continue to expand and its potential to bend the cost curve is one of the positive innovations taking place in healthcare."

Note: "The lessening of restrictions, plus the addition of more code options, is an encouraging sign that CMS understands the transformative role of telehealth in healthcare," says Lee Horner, president of telehealth at Stratus Video in Clearwater, Fla. "Telehealth is vital to achieving the triple aim in healthcare - improving the patient experience of care, improving population health, and reducing the cost of care."

Resources: See the MPFS fact sheet at www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-07-13-2.html and the CY 2018 proposed MPFS at www.gpo.gov/fdsys/pkg/FR-2017-07-21/pdf/2017-14639.pdf.