Navigating health reform
AMA Provides Guidance on 2017 CPT Coding Changes and Revised Language
The American Medical Association (AMA) has recently provided guidance on upcoming current procedural terminology (CPT) coding changes. The interventional radiology area was hit with numerous bundlings of procedures in 2016, and that trend will continue into 2017 with the final group of revised angioplasty codes. In addition to surgical codes, anesthesia, as well as physical medicine and rehabilitation, received entirely new code sets for Moderate Sedation Services and evaluation services, respectively.
The AMA has also discussed its work within the Relative Value Scale Update Committee (RUC). This panel of physicians makes recommendations to the government on the resources required to provide the medical services described in the CPT code. The RUC highlighted the following health care common procedure coding system (HCPCS) and CPT codes, which will receive payment starting January 1, 2017:
- Cognitive Impairment Assessment and Care Plan Services (G0505) — This G-code will be replaced with a CPT code for CY2018. All 10 of the following elements required to use this code:
- Cognition-focused evaluation including a pertinent history and examination.
- Medical decision making of moderate or high complexity (defined by the evaluation and management (E/M) guidelines).
- Functional assessment (e.g., Basic and Instrumental Activities of Daily Living), including decision-making capacity.
- Use of standardized instruments to stage dementia. o Medication reconciliation and review for high-risk medications, if applicable.
- Evaluation for neuropsychiatric and behavioral symptoms, including depression, including use of standardized instruments.
- Evaluation of safety (e.g., home), including motor vehicle operation, if applicable.
- Identification of caregivers, caregiver knowledge, caregiver needs, social supports, and the willingness of caregiver to take on caregiving tasks.
- Advance care planning and addressing palliative care needs, if applicable and consistent with beneficiary preference.
- Creation of a care plan, including initial plans to address any neuropsychiatric symptoms and referral to community resources, (e.g., adult day programs, support groups).Care plan must be shared with the patient and caregiver and provided with initial education and support.
- Psychiatric Collaborative Care Management Services (G0502, G0503, and G0504) — These codes will be replaced by CPT codes in CY2018.
- Non-Face-To-Face Prolonged Evaluation and Management Services (99358 and 99359) — CMS will no longer bundle these codes and will allow for separate payment.
Changes have been made to care management codes to reduce the administrative burden associated with the above codes. The requirements are outlined in detail in CPT, but the changes focus on patient consent, IT requirements, and the time frame in which the patient was last seen by the provider.
In the Medicare final rule, Post-Operative Follow-Up Visit code (99024) will be required to be reported for services related to global procedures starting July 1, 2017. This mandatory requirement is only applicable to practices with 10 or more practitioners in the states of Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island. CMS is gathering data on services furnished within the global period and will use this data in CY2019 to value surgical services.
Changes effective January 1, 2017
Prior to the end of the year, the revenue cycle/chargemaster team, physician practice managers and billers, and outpatient hospital coders should review each chapter of the CPT Professional Edition to determine which changes affect their organization. In some cases, the use of the codes has been clarified or changed, and this information should be shared with all affected departments, as well as the coding staff. Clinicians in all departments should be aware of revised, added, or deleted codes.
Specific coding changes
Six new codes have been added to describe moderate sedation services: 99151 – 99153 and 99155 – 99157. The initial moderate sedation service has been reduced from 30 to 15 minutes. The add-on code time increments remain at 15 minutes.
End Stage Renal Disease Monthly Capitation Payment, advanced care planning, and new G-codes for critical care (G0508 and G0509) have been added to Medicare’s list as telehealth services. CPT has added a new modifier, 95, to indicate that the telehealth service has been rendered via a Real Time Interactive Audio and Video Telecommunications System. However, CMS does not recognize this modifier, and the GT modifier should be used for Medicare patients. Refer to Appendix P in the CPT Professional Edition for a complete list of codes that qualify for synchronous telemedicine services.
Vaccination codes no longer have age indications as part of the CPT code descriptions. This language has been replaced by dosage amounts. There is also a new vaccine code for the Influenza Virus Vaccine: 90674.
The psychotherapy code guidelines have been revised. These guidelines affect codes ranging from 90832 to 90838. The time rules are clearly defined and instructions have been provided on how to report both individual and family psychotherapy services when performed on the same day.
Physical medicine and rehabilitation
The physical medicine and rehabilitation initial evaluation and re-evaluation codes for physical therapy (97001 and 97002), occupational therapy (97003 and 97004), and athletic training (97005 and 97006) have all been deleted and replaced with a new set of codes. The new code ranges start with CPT 97161, and there are now three levels for an initial evaluation for each sub-specialty to report. The CPT guidelines describe the criteria that constitute a low, moderate, and high complexity evaluation. One re-evaluation CPT code still remains for each sub-specialty. At this time, the RUC applied the same RVU to all three evaluation levels. However, it is important to report the appropriate level for compliance with CPT guidelines, as well as for the purpose of providing data to CMS for future RUC updates.
Section coding changes
- Retinal Detachment Repair (67101, 67105) — revised codes
- Provocative Test for Glaucoma (92140) — deleted code
- Fluorescein Angiography (92235) — revised code
- Indocyanine-Green Angiography (94420) — revised code
- Fluorescein Angiography and Indocyanine-Green Angiography Performed During the Same Encounter (92242) — new code
- Laryngoscopy (31575 – 31579) — revised codes and revised guidelines
- Laryngoscopy (31572 – 31574) — new codes
- Swallowing Therapy Services (92612 – 92617) — revised codes
- Laryngoplasty (31580 – 31592) — revised, deleted, and new codes throughout this section
- New instrumentation codes (22853 – 22859 and 22867 – 22870)
- Changes made to guidelines
- Category III codes have been replaced by Category I codes for the following:
- Closure of Left Atrial Appendage (33340)
- Closure of Paravalvular Leak (93590 – 93592)
- The Category III codes for Optical Coherence Tomography have been deleted. This should be reported with the revised Category I codes 92978 and 92979.
- Open Aortic Valvuloplasty
- New codes 33390 and 33391 replace codes 33400 – 33403.
- Replacement of Aortic Valve (33405 – 33410) — revised codes
- Esophageal Sphincter Augmentation
- New codes 43284 and 43285 replace codes 0392T and 0393T.
- Bunionectomy Revisions
- CPR eliminated legacy names such as Keller, McBride, and Mayo.
- New and revised codes in the 28289 – 28299 range allow for simpler code structure.
- The Dialysis Circuit (Hemodialysis Access and Maintenance) section has been revised to reflect bundled codes that include all aspects of the service (fluoroscopic guidance, radiological supervision and interpretation [RS&I], etc.).
- 36901 – 36909 describe these services.
- CPT contains detailed guidance on coding for these services.
- Endovascular Vein Ablation
- Codes 36473 and 36474 replace codes 36476 and 36479.
- Endovascular Revascularization (transluminal balloon angioplasty, open or percutaneous)
- New codes 37246 – 37249 replace codes 35450 – 35476 and 75962 – 75978.
- The new codes incorporate the RS&I and approach.
- There are now only two codes sets: one for the vein and one for the artery.
- Abdominal Aortic Ultrasound Screening (76706) — new code
- Fluoroscopic Guidance (77002 – 77003) — revised codes
- Mammography, Computer-Aided Detection (CAD)
- 77055 – 77057 and 77051 – 77052 have been deleted.
- G0202 – G0206 have been bundled into three new codes.
- 77065, 77066, and 77067 are the new mammography codes; CAD is no longer separately reported.
- Epidural Steroid Injections
- New codes 92320 – 92327 distinguish between injections that include imaging guidance, the anatomic location, and if the injection is a single injection or a continuous infusion. As a result of these new codes, 62310 – 62319 have been deleted.
- The guidelines for these codes have been revised.
- Presumptive Drug Class Screening codes (80300 – 80304) have been deleted and replaced with codes 80305 – 80307.
- New and revised codes in the molecular pathology section along with revised guidelines
- New and revised codes in the chemistry section
- A new CPT section has been created for Proprietary Laboratory Analyses (PLA) codes.
How we can help
The 2017 CPT code changes are very detailed, and this article provides only a snapshot of the changes. The operational and financial complexities of these changes could impact organizations significantly depending on the services they provide and their level of understanding of these changes. Some changes, such as the additional payments for prolonged E/M services, present opportunities to improve reimbursement. Others could strain reimbursement if they are not implemented correctly and monitored closely.
CLA has assisted a variety of organizations in understanding the impact of these changes. We can help you explore the new and emerging reimbursement opportunities and guide your organization as you adapt.