The air is getting brisk, and soon autumn leaves will fall. It seems appropriate, almost metaphorical, to change our code sets, doesn’t it? No sooner will you have acclimated to ICD-10 updates when CPT code changes come into effect on January 1st.
The 2019 CPT® (Current Procedural Terminology) code set from the American Medical Association (AMA) will bring 335 updates — adding 183 new codes, removing 75 codes from the lineup, and revising 50+ codes with key guideline, code descriptor, and/or instructional note changes.
Updates heading your way spread across specialties with, as expected, some specialties impacted more than others. This year also introduces six new evaluation and management (E/M) codes that you may use in your practice or facility, regardless of your focus specialty.
We’ll give you an overview of these noteworthy new E/M codes in Part 1 of this series. In Part 2, we’ll look at other notable CPT code changes, such as new and revised codes for fine needle aspiration (FNA) biopsy, skin biopsy, central nervous system assessments (psychological and neuropsychological testing), and adaptive behavior analysis.
So, let’s get started!
This year’s CPT® code set includes five new E/M codes that are historic firsts and pack the potential to boost utilization of care coordination services through connected health tools — specifically by making remote patient monitoring (RCM) and interprofessional Internet consultation financially feasible for clinicians.
Three of these updates refer to new RPM codes that promote the use of technology to connect with patients at home and collect data for better care management. Before we dive into the new RPM codes, let’s consider a few 2019 code changes made to clear the path for them.
Say goodbye to 99090 (Analysis of clinical data stored in computers (eg, ECGs, blood pressures, hematologic data)). The good news is: You probably won’t miss this code, which had been bundled with related E/M services. Earlier this year, though, CMS did unbundle 99091, which was a boon for practices, and fair by all accounts, once CMS weighed the work involved in reviewing and interpreting RPM data.
In the 2019 CPT® code set, however, 99091’s code description gets a new stipulating phrase.
In full, the new code descriptor reads (underline emphasis added to highlight revised text): 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.
In other words, as of January 1, you shouldn’t report 99091 more than once per patient in a 30-day period. If this seems like a step back from 2018, hold on — there’s good news.
In addition to offering separate reimbursement for RPM services through code 99091, you’ll have three new options, each of which has advantages over 99091.
Realizing that 99091 wasn’t intended to report stand-alone RPM services is key. One of the code’s chief drawbacks is that it doesn’t capture how RPM services are delivered, whether the provider is employing current technology and staffing models or not. The three new RPM code options address this issue, and also accommodate services that fail to meet 99091’s requirements. The new RPM codes are:
Now let’s look at the advantages these new codes bring to the table.
With 99457, you can report services after just 20 minutes. Probably the biggest benefit, though, is that all three new RPM codes allow you to capture payment for time spent setting up the RPM equipment and training patients on its use.
Another boon for care coordination services through connected health tools comes by way of two new codes for interprofessional Internet consultations. These new codes both reflect and support the escalating importance of employing technology to coordinate patient care between consulting and treating physicians. You will now be able to report such consultations using either of the following two new E/M codes:
Codes 99446-99449 also have been revised as follows to include the assessment of electronic health records as part of the consultation service (emphasis added): 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.
Note: The AMA is urging CMS to embrace new codes for remote patient monitoring and Internet consultation. Realize, though, that while the AMA maintains the CPT® code set with sole authority to create, revise, and delete codes as it deems necessary, CMS and other payers are not obliged to accept CPT® codes for reimbursement.
To mitigate this potential reimbursement obstacle, AMA President Barbara L. McAneny, M.D., has encouraged CMS toward the adoption of these new tech-based services, saying in a September 5, 2018 press release, “Medicare’s acceptance of the new codes would signal a landmark shift to better support physicians participating in patient population health and care coordination services that can be a significant part of a digital solution for improving the overall quality of medical care.”
At this time, CMS appears onboard, having included these five new codes in the proposed 2019 MPFS. In a July 12, 2018 press release, CMS stated, “We are also proposing to pay separately for new coding describing Chronic Care Remote Physiologic Monitoring … and Interprofessional Internet Consultation.” The final answer will arrive when CMS releases the final fee schedule.
Join us for Part 2 in this series later this week, when we continue our review of CPT code changes for 2019. We plan to explore new and revised codes for fine needle aspiration (FNA) biopsy, skin biopsy, central nervous system assessments, such as psychological and neuropsychological testing, and adaptive behavior analysis.
Master CPT® changes and coding, billing, and reimbursement guidelines in 2019 with expert coding resources:
AMA CPT® 2019 Professional Edition: Includes the complete 2019 AMA CPT code set with official descriptors, modifiers, CPT® official coding rules and guidelines, citations from CPT® Changes, CPT® Assistant, and Clinical Examples in Radiology, Appendixes, highlights and symbols for all 2019 coding, guidelines, and text changes, and more.
The 2019 Procedural Coding Advisor, the perfect companion to the AMA CPT® 2019 Professional Edition, includes coding, billing, and reimbursement alerts and symbols throughout the book, customized Alphabetic Index with thousands of entries that eliminate “See” cross-references, New/Revised/Deleted Codes Advice for 2019, G code equivalents for numerous CPT® codes, MACRA: MIPS and APMs training chapter, 60 stick-on tabs, more colored anatomical illustrations, foldout front and back covers with quick references to modifiers, and much more.