Wiki Palliative Care Coding with time changes to CPT codes for 2023

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jessicamarquez05

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Hello,

I do coding for Hospice and Palliative care. With the coding changes in 2023 we seem to be missing out on quite a bit of revenue for our Dr's. This is mostly surrounding initial/follow up visits for home and hospital as they changed minimum time requirements.
For home visits: CPT code 99347 was previously a 15 min minimum and is now 20 mins. Hospital visits: 99221 was previously a 30 min minimum and is now 40 mins and 99231 was previously a 15 min minimum and is now 25 mins.

I'm new to coding for Palliative Care, I'm used to billing E/M's. Anyone on here have any insight on this? Can we only code based on time for Palliative Care and Hospice Visits? Also, I was surprised we couldn't bill for extended time for these visits. Really any info anyone has would be appreciated.

Thanks,
Jessica
 
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With the change in time requirements as well as using MDM only (instead of hx, exam and MDM), yes, there will be services that were previously coded at a different level than by current coding guidelines.
Palliative care is one of the few types of specialties that historically coded many E&Ms by time. So while the time requirements are now higher, there are other changes that could benefit you. For example, you may count all time the provider spent that day on the service. Not only floor/unit time. And not require > 50% counseling/coordination of care.
Example where the current coding guidelines benefit you:
Provider rounds on admitted patient. Reviews labs, etc. Spends 35 minutes (and documents this). Leaves hospital and gets a call at 6p from nurse about pain issues. Provider spends another 15 minutes communicating with nurse, hospitalist, puts in additional medication orders, etc. Amends the note to reflect the 50 min total time. In 2022, you could only count the 35 minutes and must be >50% counseling/coordination of care. In 2023, you count all 50 minutes, including the 15 minutes spent at home in the evening.
If you are not already familiar, you should read (or re-read) the AMA 2023 E&M guidelines.
Don't forget, you can use MDM OR time, whichever is most beneficial. Even if a notes states 20 minutes, you can still bill 99232 if there is moderate medical decision making. While you may have historically coded on time 95% of situations, it may be more beneficial to you to code on MDM now.
 
Hi, I am new here!. This seems like a great place for help. My name is Julie and I am a newly certified CPC-A. I have been approached by my current employer to help out with palliative care coding for the hospice center that we work with. Although I have been in the hospital setting for many years and I feel very well trained in my CPC course through AAPC, I don't see any speciality training for specifically palliative care. I want to be able to provide them with the best service possible. Can anyone give me any current tips, guidelines, webinars, training, or any advice on how to be at my best with coding palliative care? Thank you in advance. I have found this thread already helpful :)
 
csperoni said:
With the change in time requirements as well as using MDM only (instead of hx, exam and MDM), yes, there will be services that were previously coded at a different level than by current coding guidelines.
Palliative care is one of the few types of specialties that historically coded many E&Ms by time. So while the time requirements are now higher, there are other changes that could benefit you. For example, you may count all time the provider spent that day on the service. Not only floor/unit time. And not require > 50% counseling/coordination of care.
Example where the current coding guidelines benefit you:
Provider rounds on admitted patient. Reviews labs, etc. Spends 35 minutes (and documents this). Leaves hospital and gets a call at 6p from nurse about pain issues. Provider spends another 15 minutes communicating with nurse, hospitalist, puts in additional medication orders, etc. Amends the note to reflect the 50 min total time. In 2022, you could only count the 35 minutes and must be >50% counseling/coordination of care. In 2023, you count all 50 minutes, including the 15 minutes spent at home in the evening.
If you are not already familiar, you should read (or re-read) the AMA 2023 E&M guidelines.
Don't forget, you can use MDM OR time, whichever is most beneficial. Even if a notes states 20 minutes, you can still bill 99232 if there is moderate medical decision making. While you may have historically coded on time 95% of situations, it may be more beneficial to you to code on MDM now.
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Hi there! I am a new CPC-A and my current job at a hospital is asking me to do palliative care coding for a hospice center we work with. Although I feel the CPC classes were in depth and I have gained a lot of knowledge, I don't feel comfortable diving right into this without out any training on this specialty. Do you have any recommendations? I have looked for specialty training in palliative care and I am not finding anything specific to that. Any help will be greatly appreciated.
 
I don't code Palliative care, but gynonc so there is some crossover. The fundamentals of E&M coding are all the same, regardless of the specialty. To me, one of the main characteristics of palliative is often to ensure you properly grasp the complexity of the patients. Assuming good documentation, capture the diagnoses that the physician is treating or that impact the treatment.
Many palliative visits are lengthy, so ensuring the clinicians capture and document time for all work on that day is key.
When coding on MDM, definitely don't forget about the data element "Category 3: Discussion of management or test interpretation ■ Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported)". That one element alone gets data to moderate, and is something palliative care physicians are doing a lot more often than most other specialties.
 
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