Primary Care Coding Alert

And look out for new ways to report data collection.

Coding for patients with chronic conditions just got a little more complex thanks to the 2019 revisions to CPT®. But the good news is that the basic elements of chronic care management (CCM), especially data collection and analysis, will become more streamlined and modernized beginning Jan. 1.

Will coding CCM affect your practice in the new year? Read on and find out.

CCM Gets a New Code for Physician Care Plan Administration …

First, a CCM refresher. Currently, if you have a patient that meets the CPT^® definition of chronic care and suffers from “multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,” and when those conditions “place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,” you know to code 99490 (Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored.) or 99487 (Complex chronic care management services, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, establishment or substantial revision of a comprehensive care plan, moderate or high complexity medical decision making; 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month) when your provider supervises a care manager or a clinical staff member who is administering the patient’s care plan.

Beginning Jan. 1, 2019, however, you will also have a new code, 99491 (Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month …), to report CCM services. “This new code will require that the physician — or a nonphysician provider for incident-to — does the work of the management, whereas the 99490 allows for clinical staff to perform the work,” according to Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California.

… While Data Collection Gets an Overhaul …

A crucial component of managing a chronically ill patient involves viewing and analyzing the patient’s long-term physiologic information from such monitoring equipment as echocardiograms, blood pressure cuffs, or blood glucose monitors. The physician or clinical staff member can then use this information to determine if the patient’s care plan is working and, if not, whether the plan needs to be revised.

Prior to this round of CPT^® revisions, you had two codes you could use to report these activities. However, this will change in the new year. CPT^® has deleted 99090 (Analysis of clinical data stored in computers (eg, ECGs, blood pressures, hematologic data)), because it is now outdated. “What was previously captured in 99090 is now included in other codes, including the new remote physiologic [or patient] monitoring [RPM] codes,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

More on them later.

For the other code, CPT^® has revised the wording. For 99091 (Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time), CPT^® 2019 is adding “each 30 days” to the end of the descriptor. This means that you will now only be able to report the code once in any 30-day period, roughly aligning the code with the reporting timeframe for 99490/99491.

... and Moves Into the Digital Age

Finally, CPT^® has introduced three new codes that specifically address RPM, where data from a medical device as defined by the FDA is transmitted directly from the patient to the provider, often via a Bluetooth connection to the patient’s cell phone:

• 99453 — Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment
• 99454 — Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
• 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.

As the code descriptors clearly state, each one delineates a step in the data collection process, from setting up the device and teaching the patient how to use it (99453), to supply of the device for daily recording or programmed alert transmissions (99454), to monitoring the data gathered and communicating any information and care plan revisions to the patient based on a provider or other qualified healthcare professional’s interpretation of the device’s data (99457). Like 99091, 99454 can only be reported once each 30 days, and 99457 is for a month, which again brings them roughly into line with the timeframe established by CCM codes 99490/99491.

How Will This Affect Your Practice?

Coders have received the new RPM codes with mixed opinions, and the effect on primary care coding remains unclear. On the one hand, the additions represent “an interesting step towards including IT-related monitoring of a patient’s chronic conditions,” according to Johnson. “However, the required documentation for these codes, such as the number of reports per month, signatures, which staff will review the results and so on seems unclear.”

We will keep a close eye on these new codes as we move toward Jan. 1 and let you know the answers to these questions in an upcoming issue of Primary Care Coding Alert.