Big changes in evaluation and management (E/M) coding have been in the works for a while—changes that you can learn about in depth in the upcoming ProfEdOnDemand webinar, “2019 CPT and CMS Changes for E/M,” presented by coding instructor Lynn Anderanin.
Do expect these updates to affect your reimbursement—and workload—for at least the next two years, Anderanin says.
The 2019 Medicare Physician Fee Schedule (PFS) Final Rule was published recently on November 23. It’s up to you to decide how helpful these guidelines really are, but do also prepare for new documentation policies that promise to reduce your administrative burden.
Here’s a closer look at the E/M CPT® code changes for 2019:
Remote Monitoring Adds 3 New Codes
Out of the six new E/M CPT® codes, three are related to remote monitoring:
Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial
- 99453, 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
And 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
As you can see, a key difference between 99453 and 99454 is that the former includes patient education on how to use certain devices; the latter does not. However, 99454 does have a time component (every 30 days).
Likewise, in order to bill for 99457, ensure that a qualified health care professional met with a patient for at least 20 minutes. Any less time spent and this code would not be valid.
99451/99452: Assessment and Management or Referral
Watch out for the wording of two additional new codes, 99451 and 99452 (emphasis added below):
- 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, Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes
With these codes, remember to keep track of what kind of services were provided, as well as how much time was spent with the patient.
99491: Chronic Care Management
Hopefully, the last new E/M code—99491—will be the easiest to remember. To use this code, a qualified health professional has to have spent at least 30 minutes with the patient per calendar month.
Sounds simple enough, but the code definition also includes the following requirements:
- 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, of course, make sure the documentation reflects all of those requirements before using 99491.
2019 Final Rule: Reduced Burden in Reality?
You’ve probably read—or read about—the proposed Medicare PFS final rule a while back. Now finalized and published, what’s changed?
Among other things, CMS is changing the following:
- Established/outpatient visits: In their documentation, providers can now focus on what’s changed since the last visit, but should still indicate they’ve reviewed prior data, and update data as necessary.
- Home visits: No need to document the medical necessity of a home visit that takes the place of an office visit.
- New and established visits: CMS is attempting to cut down on the entering of repetitive information, to help reduce your paperwork burden.
So of course you’re wondering: How will all this change my reimbursement? Especially as changes will continue through 2021 and beyond, you’ll need to keep an extra eye out for what’s new and how to adapt.
In Anderanin’s webinar, “2019 CPT and CMS Changes for E/M,” you’ll get exactly that: a clear roadmap to applying all these changes—and a thorough understanding of how new rules will impact your bottom line in 2019. January is fast approaching—get a jump on what you’ll need to know!
