There are numerous long-awaited requested changes and additions to codes from both the AMA and CMS that can be expected for the year 2020 and beyond. Many of these pertain to distance medicine and the technologies necessary to provide such services. Below are some more significant changes ahead for providers and their coding staff.
Medicare Coding Changes from CMS in 2020
Principal care management (PCM) category was created for chronic care management services for managing only one complex condition, with two temporary codes currently G2064 and G2065 describing these services. CMS is finalizing these new codes with a higher Relative Value Unit (RVU) than originally proposed, which should give a somewhat higher rate of payment when implemented.
For CY 2020’s proposed rule, CMS proposed increasing payments connected to CPT codes describing comprehensive care management services (CCM). Since then, all proposed increased payment updates have in fact been finalized, including CPT codes for transitional care management (TCM) and advanced care planning (ACP).
CMS also finalized the proposal lifting billing restrictions that pertained to chronic care management CPT codes, and which was supported by those commenting. CMS believes that increasing these flexibilities will improve access to care management services.
CMS is finalizing (temporary) code GCCC2 reflecting non-clinical staff time for CCM, with the proposed code now referred to as G2058, and which may be used two times per beneficiary within the service period. CPT codes 99487 and 99489 will continue to be used pending AMA’s further review of these services.
E/M changes and updates
Looking beyond 2020, with the publication of the intended 2021 E/M changes, Medicare has teamed with the AMA for more uniform codes for a variety of services. As many coders can attest, when CPT and Medicare don’t always line up together, Medicare may produce Healthcare Common Procedure Coding System (HCPCS) with codes for specific guidance for Medicare-contracted providers. As with all other payer contracts, providers must follow the policies and guidelines laid down by that contract, regardless of whether they match CPT guidelines.
Note that CMS is finalizing some significant changes to coding E/M including reversing some of the changes finalized previously in 2019. These will not be effective, however, until January 1, 2021 to give facilities and providers enough time to prepare for the changes.
The affected E/M codes are specific to Office or Other Outpatient Services (99201-99205, and the 99211-99215) codes. Payers, including Medicare, will be faced with deciding whether or not to adopt them. So far, there haven’t been any noteworthy changes to the observation or inpatient codes, although that may change.
Here’s a closer look at what’s affected;
- New guidelines that are specific to 99202 through 99215
- The deletion of 99201 altogether
- Changes in scoring components for new as well as established patient codes 99202 through 99215, inclusive
- Changes to typical times associated with each E/M code, again of 99202 – 99215
- Changes to the medical decision-making table
CPT Code Changes in 2020: Additions, Deletions, Revisions and More
Back in September 2019, the American Medical Association (AMA) released the 2020 Current Procedural Terminology (CPT) set of codes containing descriptors and identifiers which are assigned to medical, diagnostic and surgical services available to patients. The codes enable providers anywhere in the country to accurately report, measure, analyze and ultimately benchmark medical procedures and services.
AMA President Patrice Harris, M.D., M.A. stated that “practical code enhancements to CPT that support advancements in technology and medical knowledge available for the care of patients. This capacity ensures reliable codes are available for burgeoning tech-enabled services.”
The 2020 code set contains 394 changes, including 71 deletions, and 75 revisions as well as 248 new codes, based on input form providers, specialty medical societies and the healthcare community at large. These newer codes and revisions were intended to enable physicians and others caring for a diverse patient population with varying degrees of access to health care, whether in rural and urban settings.
Distance Medicine and Telehealth Updates
Among the most important additions to CPT are services, such as patient portals, and other novel digital communication developments allowing for better connections by physicians and homebound patients as well as other providers.
CPT has therefore added six new codes for reporting online digital evaluation services, or “e-visits.” Patient-initiated digital communications by a physician or other qualified healthcare professional include codes 99421, 99422, 99423. For patient-initiated communications with services from a non-physician healthcare professional, use codes 98970, 98971 and 98972.
In addition to remote patient care, other CPT additions include 99473 and 99474 for reporting a patient’s self-measured blood pressure monitoring.
Opioid and Substance-abuse Changes
CMS has recently finalized new bundled payments for treatment of opioid use disorder (OUD) which includes care coordination, management, psychotherapy and other counseling activities. Medication assisted treatment (MAT) isn’t included in these bundles, as billing and payment for medications under Medicare Parts B and D remain unchanged. Billing for medically necessary toxicology tests would continue being billed separately under the Clinical Lab Fee Schedule (CLFS), with the payment bundle accounting for intake activities.
CMS created two new HCPCS G-codes to describe monthly bundles of services, to implement the bundled payment, which are limited to beneficiaries with OUD. G2086 through G2088 indicate office-based treatment planning and therapy based on time length as well as month of treatment.
Staying Ahead of the Medical Coding Game
Many practices, especially smaller and independent practices, often face challenges keeping up with the latest technological advancements that impact practicing medicine, let alone the coding and billing aspects for these. Partnering with an experienced medical billing and practice management service that has been in business helping providers since 2002 is one excellent way to ensure that your billing meets the latest regulatory changes and updates while increasing reimbursements. Let M-Scribe’s experienced and highly-trained personnel help you to better manage your practice and its revenue cycle by calling us at 770-666-0470 or email us for more information.