Medicare Compliance & Reimbursement

But will Medicare actually pay for these new codes?

Good news: If your doctor goes the extra mile to keep in touch with patients between office visits, you could soon have a way to get paid for that effort.

The new CPT codes for 2008 haven't started trickling out yet. But experts say that some new evaluation and management codes could take effect in January. These would include:

• four new codes for "Behavioral Change Intervention." You would use these for things such as smoking/tobacco-use cessation and also if your doctor counsels patients on alcohol/substance abuse.

• three new telephone service codes.

• one new code for online E/M visits. This will replace category III code 0074T.

Warning: Just because you have new codes, that doesn't mean Medicare will pay, warns Marti Geron, reimbursement manager with University of Texas Southwestern Medical Center in Dallas.

The new behavioral change intervention codes may cause some confusion among coders, who won't know when to use these codes or a regular E/M, some sources note. But Geron says you should just make sure to bill for the actual services your doctor provided. If your doctor only did behavioral intervention, then you should use one of those codes.

If Medicare does pay for the behavioral intervention codes, then carriers will most likely have strict requirements for which diagnosis codes you can use, Geron adds. You will have to make sure to use a substance abuse-related diagnosis.

CPT 2007 already added two codes for Coumadin management, including telephone monitoring, notes Mary Falbo, president of Millennium Healthcare Consulting in Lansdale, PA.

At first, the Centers for Medicare & Medicaid Services seemed poised to pay for the 2007 codes, 99363-99364 (Anticoagulant management for an outpatient taking warfarin...). But then CMS changed its mind at the last moment and made the codes "Status B," or bundled. So we may not know until the last moment whether any of these new codes will obtain Medicare reimbursement, Falbo adds.

Some coders are still hoping that CMS will change the status of these Coumadin management codes for 2008.