CPT Changes 2019: So Many Updates, So Little Time!

Look out: There are more than 300 CPT® code changes for 2019, and although not all of the changes will directly affect your specialty, there is one group of new codes that will impact billers and coders across the land: Be sure you’re prepared for the six new Evaluation and Management (E/M) codes that take effect January 1, 2019.

Your practice likely prepares for the major updates to the CPT® code set every year. That preparation is crucial because even indirect code changes can be too costly to ignore, coding expert Jill Young emphasizes in her ProfEdOnDemand audio conference, “Overall CPT® Updates 2019.”

Here’s a look at just one aspect of the CPT® code changes that you’ll need to prep for if you want to make 2019 a maximum reimbursement kind of year..

Learn 6 New Codes for E/M Services

Heads up: Of the hundreds of CPT® code changes for 2019 released by the American Medical Association (AMA), the ones that receiving significant buzz are the six new E/M codes:

• 99451 — Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time
• 99452 — … 30 minutes
• 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 — … 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
• 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, 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

And Use Them Right: Meet 4 Criteria to Report 99451 & 99452

Understand: CPT® code 99451 describes a consultation lasting more than five minutes and requires only a written report to the requesting physician, according to an article from MDedge’s Chest Physician. CMS added 99451 to recognize that “oral communications don’t always occur between healthcare professionals and may facilitate consultative services in geographic areas with no specialists available,” author Mike Nelson, MD, FCCP writes.

You would report code 99452 if the clinician spent 16 to 30 minutes preparing for the referral and/or communicating with a consultant. If the treating/requesting provider spends more than 30 minutes, you would use a prolonged services code—that is, 99358-99359.

Best bet: According to the Nixon Law Group, you must meet the following four criteria to report 99451 and 99452 for interprofessional internet consultations:

1. Billing Practitioner: CMS limits billing for interprofessional services to practitioners who can independently bill Medicare for E/M services. Note that 99451applies to the consultative physician, while 99452 applies to the treating/referring physician.
2. Consent: You must document verbal patient consent in the patient’s medical record for each consultation, and the consent must include assurance that the patient is aware of applicable cost-sharing.
3. Cost Sharing: You must collect the requisite copayment from the patient for each service billed, as is customary with all Medicare Part B services.
4. Benefit: The consultation must be for the patient’s benefit. Because the patient will be responsible for cost-sharing, make sure you distinguish these interprofessional internet consultations from those undertaken for the practitioner’s own benefit or learning (such as a professional courtesy or as continuing education).

Note: Also, you may report the new E/M code 99457 during the same service period as chronic care management services (99487, 99489, 99490), transitional care management services (99495, 99496), and behavioral health integration services (99484, 99492, 99493, 99494), according to the American Academy of Pediatrics (AAP).

Fulfill 3 Requirements to Use 99491

Essential: Finally, AAP explained that you may report CPT® code 99491 for 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 patient’s death;
• Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; and
• Comprehensive care plan has been established, implemented, revised, or monitored.

Bottom line: These six new E/M codes are only the tip of the proverbial iceberg when it comes to the CPT® code changes for 2019.

Make sure your medical practice stays on top of all this year’s looming code changes, so you can avoid claim denials and maximize your deserved reimbursement, stresses Jill Young in her multispecialty audio conference on how to upgrade your skills to meet the demands of 2019 CPT® coding.