Significant changes to the 2019 Current Procedural Terminology (CPT®) code set will have you scrambling to revamp your billing processes for Evaluation and Management (E/M) services. Find out which codes will look different come January 1, 2019—and how the changes will affect your pediatrics office.
Brace yourself: You have to contend with changes to both CPT® and ICD-10 code sets, and the revisions will have a big impact on pediatric practices, according to coding guru Donelle Holle who hosts 4 specialty-specific sessions of the 2019 Coding Updates Virtual Boot Camp for Pediatrics. Take note, she says, the Centers for Medicare & Medicaid Services (CMS) has revised and added E/M codes, along with a new code for chronic care management.
New E/M Codes: Heed Specific Rules for 99453/99454
CMS released the 2019 CPT® code set on September 5, 2018. The updates included 335 code changes, many of which focused on capturing healthcare providers’ increasing use of new communication technologies, according to the American Medical Association (AMA).
Pay attention: The newly added CPT® codes reflect remote monitoring of patients and inter-professional communications:
- 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
Note: For the new remote monitoring codes 99453 and 99454, the American Academy of Pediatrics (AAP) stated that the equipment used must be a medical device as defined by the U.S. Food and Drug Administration (FDA). A physician or other qualified healthcare professional must order the service, and monitoring must be provided for more than 16 days.
Mistake: Don’t report 99453 and 99454 when the services are included in other codes for the time that the physiologic monitoring service occurred—for instance, when you’re reporting 95250 for continuous glucose monitoring requiring a minimum of 72 hours of monitoring. You may code 99453 only once per episode of care.
Learn Revised Consultation Codes 99446-9
Watch out: CMS also revised a variety of codes that will impact your pediatric practice.
For instance, CMS revised 99446 through 99449 to include communication via the electronic health record (EHR):
- 99091 — Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days
- 99446 — Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review
- 99447 — … 11-20 minutes of medical consultative discussion and review
- 99448 — … 21-30 minutes of medical consultative discussion and review
- 99449 — … 31 minutes or more of medical consultative discussion and review
Review all CPT Updates for 2019
Be sure to take a look at all the 2019 CPT® code updates, which include new and revised codes for skin biopsy, fine needle aspiration biopsy, and central nervous system assessments, according to the Wisconsin Medical Society.
What’s more: In addition to these E/M CPT® code changes, you should also be on the lookout for revisions to the developmental and behavioral screening codes and Z codes, which will also affect your pediatric CPT coding, advises Donelle Holle in her 4 pediatrics sessions of the 2019 Coding Updates Virtual Boot Camp.
