Coding Tip of the Month

OPTUM Insider Newsletter: January Focus – Major depressive disorder (MDD)

Modernizing Medicare Physician Payment by Recognizing Communication
Technology-Based Services

  • CMS has issued its final 2019 Physician Fee Schedule and Quality Payment Program, opening
    the door to reimbursement for connected care services that enable providers to manage and coordinate care at home. The changes are focused on three new CPT codes that separate
    Remote Patient Monitoring (RPM) services from telehealth.

The new CPT codes are:

  • CPT code 99453:“Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.”
  • CPT code 99454:“Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each
    30 days.”
  • CPT code 99457:“Remote physiologic monitoring treatment management services, 20
    minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.”
  • CMS has finalized two newly defined physician’s services utilizing communication technology. These two services are the brief communication technology based service, or virtual check in (HCPCS code G2012), and the remote evaluation of recorded video and/or images submitted (HCPCS code G2010). These services will allow practitioners to decide whether an office visit or other medical service is needed, improving efficiency and convenience for both the practitioner and beneficiary.
  • HCPCS code G2012: CMS states the code allows “audio-only real-time telephone interactions
    in addition to synchronous, two-way audio interactions that are enhanced with video or other kinds of data transmission.”  (Note: telephone calls that involve only clinical staff cannot be billed using HCPCS code G2012 since the code explicitly describes (and requires) direct interaction between the patient and the billing practitioner.)
  • HCPCS code G2010: CMS defines this code as; remote evaluation of recorded video and/or images submitted by an established patient.

Evaluation and Management (E/M) 2019 Documentation Updates

  • Beginning January 1, 2019, Medicare will allow ancillary staff to perform and record the chief complaint and history of present illness.
  • Additionally, for established patient office/outpatient visits, when the medical record already contains relevant information, Medicare will allow physicians to focus their documentation on what has changed since the last visit, or on pertinent items that have not changed, and not re-record the defined list of required elements. Physicians will still need to review prior data, update it as necessary, and indicate in the medical record that they have done so.
  • These updates were approved to help improve physician’s workflow to provide more focus on the
    patient during the office visit.
  • CMS has delayed additional E/M additional documentation changes until 2020 and 2021. Updates will be made available as more information is released from CMS.

Contact Shawn Bromley at shawn.m.bromley@lahey.org or 978-236-1704 if you are interested in more information regarding the new Telehealth services or need additional guidance on the updated E/M documentation requirements.