Medical billing is always changing. If you tried to sort through it all and keep it straight, you wouldn’t have any time for your medical practice.
But since it’s our job to stay up to date on such things – and make your life easier – we’ve collected the many details about the code changes that took effect on 1 January 2019, and we’re boiling it all down to what’s important to YOU.
Below, we’ve included sections on how the code changes affect
- Evaluation & Management (E&M)
- Remote Physiologic Monitoring
- Physical Therapy
- Outpatient Therapy
Overall, patients are demanding more accountability from healthcare providers and payers. This is a positive move within the industry, in favor of patients over paperwork. But it will change how medical providers bill insurance companies and patients.
Remote Monitoring: A Major Change for All:
This year, there’s 1 key change that applies across all specialties: it is now much simpler to bill for remote monitoring.
This year, practices operating remote patient care can use 3 new codes to
- Reimburse for less time spent by clinical staff
- Supply patients with health-monitoring devices
- Set those devices up for patient use
In this post, we’ll share more detail on these codes, including info on exactly when to use them.
Practice Expense Pricing Update:
Another important change that applies to all specialities is the Practice Expense (PE): Market-Based Supply and Equipment Pricing Update.
Since supply and equipment prices were last systematically developed in 2004 – 2005, the Centers for Medicare & Medicaid Services (CMS) is finalizing more timely updates to physician and practitioner expenses. Categories can include
- Clinical labor
- Medical supplies
- Medical equipment
- Administrative labor
- Office expenses etc.
Evaluation & Management (E&M):
Evaluation and management (E&M) coding makes up around 2/3 of reported codes.
In the past, the process for these codes has been so time-consuming that complaints poured in about more time going to paperwork than patients.
The following code changes work to remedy this.
Office or Outpatient Visit:
Beginning this year, when relevant information is already contained in the medical record, practitioners may
- Choose to focus documentation on what has changed since the last visit – or on pertinent items that have not changed
- Opt not to re-record the defined list of required elements, if there is evidence that the practitioner reviewed the previous information and updated accordingly
CMS is expected to implement payment, coding, and other documentation changes in levels 2 – 4, to further reduce billing and documentation complexities for
- Single rates for established and new patients
- Add-on codes for visits that describe additional resources
- A new “extended visit” add-on code, to account for the additional resources required for additional time spent
These changes allow for more flexibility in how level 2 – 4 visits are documented.
Billing practitioners can opt to use either the current framework or bill for medical decision-making (MDM) time.
Remote Communication Technology :
When using time, medical necessity must be documented. This includes the use of communication technology to determine whether an office visit or other service is needed.
2 new codes represent important updates in this area:
- Brief communication technology-based service, e.g. virtual check-in: HCPCS code G2012
- Remote evaluation of recorded video and/or images submitted by an established patient: HCPCS code G2010
Remote Physiologic Monitoring Codes :
In addition to the above code changes relating to communication technology, 3 important changes affect chronic care remote physiologic monitoring codes:
- Remote monitoring of initial physiologic parameters such as weight, blood pressure, pulse oximetry, respiratory flow rate, etc. + set-up and patient education on equipment use: CPT code 99453
- Remote monitoring of initial physiologic parameters such as those mentioned above + 30-day device supply of daily recordings or programmed alerts transmission: CPT code 99454
- Remote physiologic monitoring treatment management services (20+ minutes/month of patient/caregiver communication with qualified healthcare professional): CPT code 99457
Physical Therapy :
Assuming that services are confirmed medically necessary as justified by appropriate documentation in the medical record, the 2019 threshold amount for using the KX modifier is as follows
- $2,040 for PT and SLP services combined
- $2,040 for OT services
The fee schedule conversion factor is now 36.0463. This reflects the +0.25% statutory update factor reduced by the 2019 RVU budget neutrality adjustment of -0.12%.
CMS made only minor adjustments to the values of CPT codes in the physical medicine and rehabilitation family.
Outpatient Therapy :
A handful of changes affect outpatient therapy services provided on or after 1 January 2019:
First, G-codes and modifiers are no longer required by Medicare.
Secondly, CMS has 2 new modifiers for therapy services provided by therapy assistants:
- CQ modifier: outpatient physical therapy services furnished in whole or in part by a physical therapist assistant
- CO modifier: outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant
There have been no changes to the following three modifiers for outpatient services delivered:
- GP–physical therapy plan of care
- GO–occupational therapy plan of care
- GN–speech-language pathology plan of care
Cardiology has seen a number of new codes and revisions of codes. The following sections are organized based on procedure and service:
Leadless Pacemaker Procedure :
The leadless pacemaker procedure saw 5 revised codes (93279, 93286, 93288, 93294, 93296) and the addition of 2 new codes:
- Removal & replacement of leadless pacemaker system during the same session: 33274
- Removal of leadless pacemaker without replacement: 33275
Cardiac Event Recorder Procedure :
The cardiac event recorder procedure saw 6 revised codes (93285, 93290, 93291, 93297, 93298, 93299) and the addition of 2 new codes:
- Insertion of subcutaneous cardiac rhythm monitor including programming: 33285
- Removal of subcutaneous cardiac rhythm monitor: 33286
Pulmonary Wireless Pressure Sensor Services :
Pulmonary wireless pressure sensor services saw no revisions and the addition of 2 new codes:
- Transcatheter implantation of a wireless pulmonary artery pressure sensor: 33289
- Remote monitoring of a wireless pulmonary artery pressure sensor for up to 30 days: 93264
Category III Wireless Cardiac Stimulation :
The Category III Wireless Cardiac Stimulation saw no revisions and the addition of 8 new codes:
- Insertion of a wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performed; complete system, including electrode and generator (transmitter and battery): 0515T
- Electrode only: 0516T
- Pulse generator components (battery and/or transmitter) only: 0517T
- Removal of only pulse generator components (battery and/or transmitter) of wireless cardiac stimulator for left ventricular pacing: 0518T
- Removal and replacement of wireless cardiac stimulator for left ventricular pacing; pulse generator components (battery and/or transmitter): 0519T
- Pulse generator components (battery and/or transmitter), including placement of a new electrode: 0520T
- Interrogation device evaluation (in person) with analysis, review, and report, includes connection, recording, and disconnection per patient encounter, wireless cardiac stimulator for left ventricular pacing: 0521T
- Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, including review and report, wireless cardiac stimulator for left ventricular pacing: 0522T
The following changes for medical coding in dermatology will require practices to code biopsies based on the method of removal.
Effective 1 January 2019, codes 11100 and 11101 were eliminated.
6 new codes provide specificity surrounding the depth and technique of biopsies:
- Tangential biopsy of the skin (i.e., scoop, curette, shave, saucerize) a single lesion: 11102
- Each additional/separate lesion (list separately along with the code for the primary biopsy): 11103
- Punch biopsy of the skin (including simple closure if performed) for a single lesion: 11104
- Every additional/separate lesion (should be listed separately along with the code for primary biopsy): 11105
- Incisional biopsy of the skin (i.e., wedge), along with simple closure if performed, single lesion: 11106
- Every additional/separate lesion (list separately along with the code for the primary biopsy): 11107
The Bottom Line :
Whew! That’s a lot of big changes. But we’re here to support you every step of the way.