Podiatry Coding & Billing Alert

Check out new online digital code 99421.

Although you won’t see many podiatry-specific CPT® 2020 changes this year, you shouldn’t miss several evaluation and management (E/M) additions, revisions, and deletions.

Take a look at the E/M changes you should learn before they take effect on Jan. 1, 2020.

Online E/M Code 99444 Deleted, New Codes 99421-99423 Added

Deletion: CPT^® 2020 will delete current online E/M code 99444.

Additions: In place of 99444, you will receive new code 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).

Like its predecessor, 99421 has some significant restrictions, which stipulate that the service has to be:

• Provided to an established patient (or guardian),
• Provided by a physician or other qualified health care professional (QHP), and
• Unrelated to an E/M service provided within the previous seven days.

This means that any online digital E/M service that results from a previous visit or that results in a subsequent E/M visit is not separately reported, and the online E/M service is incorporated into the related E/M visit.

Also, CPT^® has placed a seven-day cumulative time limitation on 99421 and made the code time-dependent. You will be able to use 99421 if your provider spends between five and 10 minutes on any asynchronous communications with the patient in that time; you will also be able to report longer time increments with new codes 99422 (… 11-20 minutes) or 99423 (… 21 or more minutes).

The deletion of 99444, and its replacement with 99421-99423, presents a teachable moment for coders and their providers.

“Coders will need to work with their providers to ensure that they are documenting the time factors of the new codes,” says 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.”

Catch Time Change for Virtual QNHP E/M Codes

CPT^® 2020 will delete 98969 (Online assessment and management service provided by a qualified nonphysician health care professional …), and in its place, you’ll be able to use three new time-based codes to report the same, asynchronous online services to your patients:

• 98970 (Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes)
• 98971 (… 11-20 minutes)
• 98972 (… 21 or more minutes).

The changes here have been welcomed by our coding experts, as they bring the codes into line with several similar services.

“These new codes mimic the qualified nonphysician health care professional [QNHP] telephone call codes 98966-98968 [Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment …], which have the same stipulated times,” says Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana.

“They also mirror what has been done to the corresponding physician code 99444,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

But both experts add a note of caution about the new codes, especially in terms of the criteria that need to be met in order for them to be used. “As noted in the descriptor, these codes are for QNHPs,” Moore says. Additionally, “they can only be used for established patients,” Holle explains.

Lastly, “coders will need to work with their providers to figure out how the provider is going to track the time over the seven days and report the appropriate code when the seven days are up,” Moore says. And even if you follow the guidelines to the letter, “like the telephone call codes, these new digital codes may not be payable,” Holle says. Consequently, coders should check with the payers to whom they submit claims most often to learn how those payers intend to handle these codes.

Dive Into RPM Revision and Addition

CPT^® 2020 will also bring a few changes to remote physiological monitoring (RPM) codes.

Revision: Check out this revision to RPM code 99457 (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; first 20 minutes) (Emphasis added.)

As you can see, this revision is merely a simple change in the parent code’s time parameters.

Addition: CPT^® 2020 will give you the new code 99458 (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; each additional 20 minutes (List separately in addition to code for primary procedure), which will allow you to report additional 20-minute increments of your physician’s RPM service time.