Download presentation
Presentation is loading. Please wait.
Published byPeregrine Waters Modified over 5 years ago
1
2020 CPT Changes: Marsha S. Diamond, CPC, COC, CCS, CPMA, AAPC Fellow
01/21/20 Greater Orlando AAPC Chapter
2
TODAY’S AGENDA E/M Changes 2020 and Beyond Surgery Updates
Radiology Updates Pathology Updates Medicine Updates This Photo by Unknown Author is licensed under CC BY-ND
3
2020 E/M CPT Changes: CPT Has Entered the Digital Age!
4
NEW CODES FOR ONLINE DIGITAL E/M
Deletion of and replacement with the following more specific codes: 99421 Online digital evaluation and management service, EP, for up to 7 days cumulative time during the 7 days; minutes minutes or more minutes Must be type that would be done face-to-face Performed through HIPAA compliant secure platform Must be patient-initiated May be billed by clinicians who are qualified to independently bill E/M Cannot be used by clinical staff/clinicians who do not have E/M services in scope of practice
5
Additional Guidelines for Online Digital E/M Services
Report only once during 7-day period 7-day period begins with physician or other QHP (qualified health professional) initial, personal review of patient-generated inquiry Cumulative service time includes: - review of patient records or data pertinent to assessment of problem - personal physician or QHP interaction with clinical staff focused on patient’s problem, development of management plan, including generation of prescriptions, ordering tests and communication with patient through online, telephone, or other digitally- supported communication which does not represent separately reportable E/M service
6
Other Stipulations for Use of Digital Online E/Ms
Online interaction must be documented in permanent record If within seven days of initiation of online service, a face-to-face E/M service occurs, time of online service or MDM complexity may be utilized by selecting a face-to-face E/M service, but, the online digital service may not be billed If patient initiates online service within 7 days of an E/M service for the same problem, the online service is not billable If patient initiates online service within 7 days of an E/M service for a new problem, the online service is billable Only for established patients HIPAA compliance securing platform is defined as a platform such as electronic health record portal, secure or other digital applications
7
New Codes for Other Professionals for Online Services
Applicable to other professionals who may not bill E/Ms such as speech-language pathologist, physical therapists, occupational therapists, social workers, dieticians for example Medicare is not recognizing these codes because definition includes word “evaluation” and these professionals are not allowed to perform those services CPT codes 98970, and 98972 Medicare developing HCPCS codes (to be released 11/2019)
8
HCPCS CODES FOR QHP DIGITAL ONLINE SERVICES
GNPP1 Qualified non-physician health care professional online assessment, established patient, for up to seven days, cumulative time during the 7 days; minutes GNPP minutes GNPP or more minutes
9
Examples of Device/Technology for Chronic Care Remote Monitoring Codes
Chronic Condition Example Device(s) Diabetes Glucometer monitoring Obesity Caloric intake monitoring Hypertension Ambulatory monitoring device; manual monitoring devices Cardiac arrhythmia Heart rate monitor, cardiac rhythm monitor Dementia Video surveillance devices, locations tracking devices Lung disease Continuous pulse oximetry monitoring
10
CHRONIC CARE REMOTE MONITORING CODES
99453 Remote monitoring of physiological parameters) (e.g. weight, blood pressure, pulse oximetry, respiratory flow rate), initial, set up and patient education on use of equipment Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other QHCP time in a calendar month requiring interactive communication with the patient/caregiver during the month
11
COLLECTION AND INTERPRETATION OF DATA FOR REMOTE MONITORING
99091 Collection and interpretation of physiologic data (e.g. ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days Does not require interactive communication such as 99457 Requires physician or other QHP to perform Requires 30 minutes every 30 days to bill 99457 and cannot both be billed concurrently
12
REQUIREMENTS FOR USE OF REMOTE MONITORING CODES
Patient must opt-in to service (must be documented) Device must meet FDA definition of medical device Device must be supplied for at least 16 days for current billing period Service must be ordered by MD or other QHP Data must be wirelessly synced where it can be evaluated Data-monitoring may be performed by MD, QHP or clinical staff. Clinical staff may include RN, medial assistants, depending on state law and scope of practice
13
COMPARISON OF USE OF 99457/99091 CPT Code 99457 CPT Code 99091
Requires 20 minutes professional time per calendar month Requires 30 minutes professional time per 30 day period Time spent by physicians/QHCP or clinical staff (cannot be billed incident to) Reimbursed only for physicians or QHCPs Requires interactive communication between provider and patient/caregiver No communication required
14
IMPORTANCE OF MDM AND ITS ROLE IN 2021 E/Ms
This Photo by Unknown Author is licensed under CC BY-SA-NC
15
MEDICAL DECISION-MAKING COMPONENTS REDEFINED
CPT DIAGNOSIS/MGT DATA RISK 2019 Number of diagnosis or management options Amount and/or complexity of data to be reviewed Risk of complications and/or morbidity or mortality 2021 Number and complexity of problem(s) addressed Amount and/or complexity of data to be reviewed and analyzed Risk of complications and/or morbidity or mortality of patient management
16
MDM DEFINITIONS REDEFINED
Number of Dx/Management Options renamed “Number and Complexity of Problems Addressed” Amount and/or Complexity of Data to Be Reviewed” renamed “Amount and/or Complexity of Data to Be Reviewed and Analyzed” Risk of Complications and/or Morbidity or Mortality renamed “Risk of Complications and/or Morbidity or Mortality of Patient Management” This Photo by Unknown Author is licensed under CC BY-NC-ND
17
MDM OR TIME WILL BE DETERMINING FACTOR FOR E/Ms 99202-99215
Medical decision making or time will be the basis for code selection in 2021 Time definition will be redefined as follows: CPT Time Definition 2019 Typical time (with summary of face-to-face counseling and/or coordination of care) 2021 Total time This Photo by Unknown Author is licensed under CC BY-SA-NC
18
IMPLEMENTATION CHANGES TO E/Ms FOR 2021
19
GENERAL CHANGES TO E/M FOR 2021
Will be included in CPT 2021 Medicare may produce HCPCS codes with specific guidance for Medicare-contracted providers in some instances CPT code will be deleted from CPT History and exams will still be required “commensurate” with the level of service reported, however, no auditing will be performed for these components MDM or time will be the determining factor for Time component redefined (as previously discussed) Elimination of requirement to re-document information previously documented by clinical staff or on previous visit(s)
20
ADDITIONAL CHANGES TO E/M SECTION OF CPT
Restructuring of E/M guidelines into 3 subsections: - Guidelines common to all E/M Services - Guidelines for Hospital Observation, Hospital Inpatient, Consultations, Emergency Department, Nursing Facility, Domiciliary, Rest Home or Custodial Care and Home E/M Services - Guidelines for Office or other Outpatient Retain 5 levels for Office/Outpatient Established Patients Reduce Office/Outpatient New Patients to 4 levels (eliminating 99201)
21
What Can YOU Do to Prepare?
Keep up-to-date on upcoming changes Make your practice aware of the changes Develop an impact analysis for your practice Utilize your practice’s service analysis/productivity report to determine the specific impact to your practice Financial impact will not be as significant as originally proposed, since 5 EP levels and 4 NP levels will remain for Outpatient/Office Work on educating providers on documentation requirements for MDM Recent MARSI audit demonstrated that 37-42% of all E/Ms did not meet MDM for level assigned
22
How Do We Benefit? Decreased Risk for Audit
As part of proposed changes, CMS intent on decreasing amount of chart reviews/audits Decreased Burden of Documentation Requirements Physicians will be able to document less in many instances, and not be as concerned about meeting “bullets”
23
How Will This Affect the Coding Industry and You?
Change on Focus While coder/auditor of E/M levels may not be auditing levels to the same extent, their primary role will be determine which elements will be utilized by the practice for determining their levels and making sure all elements are met Documentation Review Will still involve reviewing based on time or MDM Ensure Appropriate Documentation is Validated by Provider Chief complaint/Patient History Changes in History/Exam from Previous Visit(s)
24
2020 Surgery Changes: Integumentary-Nervous System
This Photo by Unknown Author is licensed under CC BY
25
New Codes Autologous Grafting CPT Codes 15769-15774
15769 Autologous soft tissue grafting, other, harvested by direct excision(e.g. fat, dermis, fascia) Harvested by liposuction technique, trunk, breasts, scalp, arms and/or legs, 50 cc or less injectate each addtl 50 cc injectate or part thereof Harvested by liposuction technique, face, eyelids, mouth, neck, orbits, genitalia, hands and/or feet, 25 cc or less injectate each addtl 25 cc injectate or part thereof
26
Deletion of Mastectomy Codes
19260 Excision chest wall tumor including ribs (moved to M/S CPT code 21601) with plastic reconstruction, w/out mediastinal lymphadenectomy (new CPT code 21602) with mediastinal lymphadenectomy (new CPT code 21603) 19304 Subcutaneous Mastectomy
27
New Codes Musculoskeletal Section
Needle insertion, without injection (1-2 muscles) or more muscles Drug Delivery Devices Manual preparation* and insertion drug delivery device, deep (subfascial) Removal drug delivery device, deep Manual preparation and insertion drug delivery device, intramedullary Removal drug delivery device, intramedullary Manual preparation and insertion drug delivery device, intraarticular Removal drug delivery device, intraarticular * Includes mixing/preparation of drugs or therapeutic agent and shaping mixture for insertion This Photo by Unknown Author is licensed under CC BY
28
Edit to Nasal Endoscopy Codes
Codes (Nasal endoscopy/surgical) Removal of word “dilation” from description This Photo by Unknown Author is licensed under CC BY-NC-ND
29
New Codes Cardiovascular (Pericardium)
33016 Pericardiocentesis, including fluoro/US imaging 33017 Pericardial drainage with insertion indwelling catheter, includes imaging, months or older w/out congenital cardiac anomaly birth – 5 years or any age with congenital cardiac anomaly 33019 Pericardial drainage with insertion indwelling catheter, w/CT guidance
30
Additional Endovascular Repair Codes
Iliac artery at time of aorto-iliac artery endograft placement by deployment of iliac branched endograft (all radiological services inc), and all endograft extensions proximally to the aortic bifurcation and distally in the internal iliac, external iliac and common femoral arteries and treatment zone angioplasty/stent when performed 34718 Iliac artery, not associated with placement of aorto-iliac endograft at the same session, by deployment of iliac branched endograft, includes sizing and device selection, all ipsilateral selective iliac catheterization, all radiological services, and all endograft extensions proximally to the aortic bifurcation and distally in the internal iliac, external iliac and common femoral arteries and treatment zone angioplasty/stent when performed
31
Addition of Exploration Cardiovascular Codes
35702 Exploration, not followed by surgical repair, upper extremity lower extremity
32
New Hemorrhoidectomy Code
46948 Hemorrhoidectomy, internal, by transanal hemorrhoidal dearterialization, 2 or more columns/groups, including guidance when performed
33
Abdomen, Peritoneum/Omentum
49013 Preperitoneal pelvic packing for hemorrhage associated with pelvic trauma (includes local exploration) 49014 Re-exploration pelvic wound with removal preperitoneal pelvic packing, including repacking, when performed.
34
SPINAL INJECTION/DESTRUCTION CODE ADDITIONS
64451 Injection, Anesthetic Agents, and/or Steroids, innervating sacroiliac joint w/imaging genicular nerve branches w/imaging, when performed 64624 Destruction by neurolytic agent, genicular nerve branches, w/imaging, when performed 64625 Radiofrequency ablation, nerves innervating sacroiliac joint, with imaging guidance This Photo by Unknown Author is licensed under CC BY-SA
35
NEW CATARACT REMOVAL CODES
66987 Complex extracapsular cataract extraction with IOL (same as 66982) with endoscopic cyclophotocoagulation 66988 Extracapsular cataract extraction with IOL (same as 66984) with endoscopic cyclophotocoagulation
36
2020 Radiology Changes: This Photo by Unknown Author is licensed under CC BY-SA
37
RADIOLOGY ADDITIONS/CHANGES
New code for double-contrast esophagus study CPT code 74221 Codes 74251/74245 codes deleted, utilized 74240 New code for small intestine follow-through study, includes multiple serial imaging
38
New Codes Myocardial Imaging
78430 Single Study, at rest or stress, with concurrently acquired CT transmission scan 78431 Multiple study (ies), at rest or stress, with concurrently acquired CT transmission scan 78432 Positron emission tomography, combined perfusion with metabolic evaluation study and/or ejection fraction, when performed, dual radiotracer with concurrently acquired CT transmission scan Absolute quantitation of myocardial blood flow, positron emission tomography, rest and stress
39
New Localization of Tumor Radiologic Codes
78830 Radiopharmaceutical localization of tumor, tomographic (SPECT) with concurrently acquired CT transmission scan for anatomic review, localization and determination/detection of pathology, single area (such as head, neck, chest, pelvic), single day imaging SPECT only, Minimum 2 areas, single day imaging, or single area imaging over 2 or more days SPECT and concurrently acquired CT transmission scan, minimum 2 areas, single day imaging, or single area imaging over 2 or more days 78835 Radiopharmaceutical quantification measurement(s), single area
40
2020 Pathology Changes This Photo by Unknown Author is licensed under CC BY-SA
41
NEW THERAPEUTIC DRUG ASSAYS
80145 Adalimumab 80230 Infliximab 80235 Lacosamide 80187 Posaconazole 80280 Vedolizumab 80285 Voriconazole
42
This Photo by Unknown Author is licensed under CC BY-NC-ND
2020 Medicine Changes:
43
ADDITIONAL MOLECULAR PATHOLOGY/PROPRIETARY LABORATORY ANALYSES
See Molecular Pathology Section for code additions 81307 81308 81309 See Proprietary Laboratory Analyses section for code additions: 0062U 0066U 0070U 0074U+ 0078U-0138U 0063U 0067U 0071U U+ 0064U 0068U 0072U U+ 0065U 0069U 0073U U
44
Additional Health Behavior Assessment and Intervention Codes
Addition of codes to encompass: Individual vs Group vs Family Individual Time (Initial 30 minutes, each additional 15 minutes0 With/Without Patient Present
45
NEW IMMUNIZATIONS 90694 Influenza Virus, quadrivalent (all V4), inactivated, adjuvanted, preservative free, 0.5 ml dosage, IM use 90619 Meningococcal conjugate vaccine, serogroups, A, C , W, Y, quadrivalent, tetanus toxoid carrier (Med ACWY-TT), for IM use This Photo by Unknown Author is licensed under CC BY-SA-NC
46
ADDITIONAL BIOFEEDBACK CODES
90912 Perineal muscles, anorectal, or urethral sphincter, inc EMG and/or manometry when performed, initial 15 minutes one-on-one qualified health care professional contact with patient each additional 15 minutes
47
ADDITIONAL OPHTHALMOSCOPY CODES
92201 Extended ophthalmoscopy, with retinal drawing and scleral depression of peripheral retinal disease (retinal tear, retinal detachment, retinal tumor), with interpretation and report, unilateral/bilateral 92202 Extended ophthalmoscopy, with drawing of optic nerve or macular (glaucoma, macular pathology, tumor) with interpretation and report, unilateral/bilateral
48
COMPLETE REVAMPING OF EEG STUDIES
Additional Codes performed by EEG Tech: 95700 EEG continuous recording, with video when performed, minimum 8 channels 95705 EEG without video, 2-12 hours, unmonitored with intermittent monitoring and maintenance w/continuous real-time monitoring and maintenance 95708 EEG without video, hours, unmonitored with intermittent monitoring and maintenance w/continuous real-time monitoring and maintenance 95711 EEG with video, 2-12 hours, unmonitored with intermittent monitoring and maintenance w/continuous real-time monitoring and maintenance
49
EEG STUDY CODES (continued)
EEG, with video, hours, unmonitored with intermittent monitoring and maintenance w/continuous real-time monitoring and maintenance Additional codes performed by MD or QHCP 95717 EEG, 2-12 hours, recorded without video with video greater than 12 hours-26 hours, without video with video greater than 36 hours-60 hours, without video with video greater than 60 hours-84 hours, without video with video greater than 84 hours, without video with video * Refer to Long-term EEG Monitoring Table, p. 715, 2020 CPT Professional Edition
50
QUESTIONS/COMMENTS/CONCERNS:
Marsha S. Diamond, CPC, COC, CCS, CPMA, AAPC Fellow & Claire
51
& Chloe Too!
Similar presentations
© 2025 SlidePlayer.com Inc.
All rights reserved.