2018 CPT® Coding Changes Hit E/M Services Hard

CPT Code Changes

Each year CPT® codes are revised and updated to accommodate current terminology, technology and practice. And 2018 is no different: According to the American Medical Association (AMA), the new year will see a number of code changes taking effect. Keeping up with the vast number of code changes may seem daunting, but a good place to start is with an overview of the guidelines for evaluation and management (E/M) coding, including added, revised and deleted codes, and new modifiers for 2018.

New and/or Revised Terminology

Coding expert Amy Pritchett, in a recent webinar for ProfEdOnDemand, discussed the new or revised terminology in the AMA guidelines.

The code 99217 for observation care discharge was revised with the addition of “outpatient hospital” within the definition of counseling and/ or coordination of care. And the 99218-99220 code sets for initial services were affected by the new and revised terminology for 2018. For observation encounters by other physicians, you’ll want to see office or other outpatient consultation codes 99241-99245, or subsequent observation care 99224-99226, she noted.

Revised Guidelines

Prolonged services codes 99354-99357 are used when a physician or other qualified health care professional provides prolonged service(s) involving direct patient contact that is provided beyond the usual service in either the inpatient or outpatient setting have revised guidelines. This service is reported in addition to the primary procedure (i.e., the designated evaluation and management services at any level, codes 90837, 90847) and other services provided at the same session. Appropriate codes should be selected for supplies provided or other procedures performed in the care of the patient during this period, according to Pritchett.

The codes 99441-99443 for telephone services and 99444 for online medical services also have revised guidelines, and there have been revisions to the guidelines for inpatient neonatal intensive care services and pediatric and neonatal critical care services.

New Categories

2018 introduces a new category for cognitive assessment and care plan services: Code 99483 will be used for assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home.

According to the guidelines, cognitive assessment and care plan services should not be reported if any of the required elements are not performed or are deemed unnecessary for the patient’s condition. For these services, the appropriate E&M code should be used. Also, a single physician or other qualified health care professional should not report 99483 more than once every 180 days, according to Pritchett.

The new category for psychiatric collaborative care management services includes codes 99492-99494.

Added Codes

A new code for general behavioral health integration care management has been added in 2018: ­Code 99484 is for care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month.

Deleted Codes and New Modifiers

The codes 99363 (anticoagulation management) and 99364 (anticoagulation management, each subsequent 90 days of therapy) have been deleted. These codes have been replaced with 93792 and 93793.

And 2018’s coding updates include the addition of two new modifiers: modifier 96 for habilitative services, and modifier 97 for rehabilitative services.

Are You Ready for January 1, 2018?

Understanding the newest codes, categories and guidelines requires that you know which codes are deleted and will no longer bring in reimbursement. Medical coding expert Amy Pritchett discusses all changes to the 2018 CPT® and HCPCS coding manuals, including in-depth coding guidelines for each chapter as well as added/revised and deleted codes in “2018 CPT® and HCPCS Updates,” a recent webinar with ProfEdOnDemand. She discusses changes to E/M coding, anesthesia, surgery, radiology, pathology and more from the CPT® manual. She also addresses new modifiers, 2018 ambulatory surgery and OPPS updates, and HCPCS codes for drug delivery implants 2018.

To join the conference or see a replay, order a DVD or transcript, or read more

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