Primary Care Coding Alert

CPT^®, CMS continue to move forward on telemedicine, E/M revisions.

The year 2019 can be summed up simply: telemedicine continued to progress and evaluation and management (E/M) continued to evolve.

Even so, it’s worth taking a look back at some of the biggest coding stories from the year, not only to remind you of the changes, but to look ahead at what might be in store in the New Year and beyond.

CMS Revised Remote Monitoring …

The 2019 Medicare Physician Fee Schedule (PFS) final rule introduced the first of many new telemedicine codes that became effective on Jan. 1. The Centers for Medicare and Medicaid Services (CMS) added G2010 (Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward) …) to the HCPCS code set, and CPT^® followed suit with three new codes for remote physiological monitoring: 99453 (Remote monitoring of physiologic parameter(s) … initial; set-up and patient education on use of equipment), 99454 (Remote monitoring of physiologic parameter(s) … initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days), and 99457 (Remote physiologic monitoring treatment management services …).

Later in 2019, CPT^® revised the time increments for 99457, changing the descriptor from “20 minutes or more … of time in a calendar month” to the “first 20 minutes,” and introducing a new code, +99458 (… each additional 20 minutes (List separately in addition to code for primary procedure)). The change to 99457 and the addition of +99458 will become effective Jan. 1, 2020, to benefit “patients requiring significant monitoring and interaction during a particular month,” and allowing your provider “to capture the additional work spent on those patients,” according to Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania.

The codes all enable providers to participate in remote physiological monitoring (RPM) of a patients’ vital signs, such as their weight, blood pressure, pulse oximetry, or respiratory flow rate, which represent “an interesting step toward including IT-related monitoring of a patient’s chronic conditions,” 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.

CPT^® 2020 also introduces revisions to the ambulatory blood pressure monitoring (ABPM) 93784-93790 code group, while introducing two new self-measured blood pressure (SMBP) monitoring codes: 99473 (Self-measured blood pressure …; patient education/training and device calibration) and 99474 (… collection of data reported by the patient and/or caregiver…).

… While Virtual Check-Ins Got the Medicare Green Light …

RPM wasn’t the only way telemedicine advanced in 2019. Along with G2010, on Jan. 1, CMS introduced the virtual check-in HCPCS code G2012 (Brief communication technology-based service, e.g. virtual check-in …), the Medicare-recognized alternative to CPT^® 99441-99443 (Telephone evaluation and management service  ) and 99444 (Online evaluation and management service…). Significantly, while G2012 only covers 5-10 minutes (the CPT^® codes cover up to 30 minutes of medical discussion), G2012 has two distinct advantages over its CPT^® counterparts, as the service can be initiated either by a patient or a physician or other qualified healthcare professional (QHP), and the communication can be via telephone call or electronic communication.

… and the E/M Revolution Continued Slowly but Surely

While the much-anticipated E/M shake-up didn’t happen in 2019, there were plenty of indications that the countdown to 2021 continues. The 2019 final rule, for example, reduced E/M paperwork, and beginning Jan. 1, you and your provider no longer had to:

• Document medical necessity for a home visit in lieu of an office visit;
• Re-record elements in the medical record if the physician reviewed the previous information and updated it as needed or noted pertinent items that have not changed;
• Re-record the patient’s chief complaint and history, and just simply indicate in the medical record that the information has been reviewed and verified, if staff or the patient have already entered the information; or
• Re-record information included in medical records by residents or other members of the medical team.

What Does All This Mean for 2021?

Simply put, you’ll need to stay informed. This means staying informed “of the upcoming changes to both CPT® and Medicare rules and then follow additional announcements from both the AMA and Medicare very closely,” Falbo advises.