The Coding Corner Archives

Coding Corner - January 2019 Edition

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 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.

Coding Corner - February 2019 Edition

CPT Coding and Billing Updates for 2019
Here are the most recent 2019 coding updates that physician’s should be aware of to ensure accuracy in coding and billing for MRI Breast Exams and new codes of Chronic Care Management.

MRI-Based Breast Exams Contrast Updated Codes:
The 2019 change deleted codes 77058 and 77059 and resulted in an expansion associated with four codes:

  • 77046: Unilateral MRI breast exams without contrast
  • 77047: Bilateral MRI breast exams without contrast
  • 77048: Unilateral MRI breast exams, with/without contrast
  • 77049: Bilateral MRI breast exams, with/without contrast

    Codes 77046
     and 77047 encompass computer-aided detection (CAD), including CAD real-time lesion detection, characterization and pharmacokinetic analysis. This change has eliminated the need to separately add the HCPCS code 0159T for situations involving CAD.

New Code for Chronic Care Management:
CPT code updates for 2019 include chronic care management (CCM). This update allows providers to bill for at least a half hour of their time.

  • 99491: Chronic care management services provided personally by a physician or other qualified healthcare professional for at least 30 minutes.
  • This code is billed for CCM coordination sessions that are more than 20 minutes but less than an hour.

Coding Tip of the Month - March 2019

Coding News from NEPHO
The Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) recommend that health care providers routinely enlist independent parties to audit coding practices. Chart audits are a way to obtain feedback regarding your coding program and help in measuring quality.

Although the goals may generally be the same, coding audits can differ in several ways, including methodology type, accuracy definitions, and cost.

Coding Audit Methodologies
Coding audits can be retrospective, which is a review of submitted claims, or prospective, an analysis of pre-billed claims. They can also be random, targeted, or a mix of both, and a code-for-code or full-record analysis.

Establishing a regular external coding audit will have a high return on investment (ROI), helping you maintain the best coding practices for the well-being of your practice. Most importantly, it will help identify potential coding and documentation problems and reduce risk of lost revenue from denials.

Coding Audits Help To:

  • Determine if day to day operating procedures are compliant with current regulations
  • Prevent non-compliance issues from occurring
  • Reduce potential for over or underpayments
  • Reduce risk of improper documentation
  • Minimize risk of fraud
  • Ensure compliance with Medicaid and Medicare standards
  • Address areas of coding education opportunity

NEPHO Coding Audit Findings:
In an ongoing effort to ensure accuracy and compliant coding NEPHO performed an outpatient service chart audit review on three NEPHO physician practices. The findings addressed areas of opportunity for provider education. A trend identified included missing preventative screening ICD-10 diagnosis codes that were released October 1, 2018.  The initial review was done in January 2019 and follow-up review was completed in February 2019. The follow-up coding review found that all 3 practices had improved with capture of the new ICD-10 diagnosis codes for screening encounters.

 Z00-Z99 Factors influencing health status and contact with health services

  • 81 Encounter for examination and observation of victim following forced sexual exploitation (ruled out)
  • 82 Encounter for examination and observation of victim following forced labor exploitation (ruled out)
  • 89 Encounter for examination and observation for other specified reasons (ruled out)
  • 30 Encounter for screening examination for mental health and behavioral disorders, unspecified
  • 31 Encounter for screening for depression
  • 32 Encounter for screening for maternal depression
  • 39 Encounter for screening examination for other mental health and behavioral disorders
  • 40 Encounter for screening for unspecified developmental delays
  • 41 Encounter for autism screening
  • 42 Encounter for screening for global developmental delays (milestones)
  • 49 Encounter for screening for other developmental delays
  • 821 Contact with and (suspected) exposure to Zika virus
  • 83 Immunization not carried out due to unavailability of vaccine
  • 430 Family history of elevated lipoprotein(a)
  • 438 Family history of other disorder of lipoprotein metabolism and other lipedemia

Please contact Shawn Bromley at  and/or 978-236-1704 if you would like to have a coding audit performed at your practice or have questions related to coding.

Coding Corner - December 2018 Edition

ICD-10- CM Diagnosis Codes Reset January 1, 2019

  • A major component of the Hierarchical Condition Categories (HCCs) model is that the individual HCCs are only valid for one year. Regardless of the HCCs fundamental chronicity, on January 1, 2019 the patient’s HCC listing will be blank.
  • For example, a patient with diabetes with complications would need to have a face-to-face encounter with a provider where diabetes is discussed and documented for the appropriate
    HCC to be reported in the new base year.
  • There are two important aspects to remember when HCC coding:
  • Analyzing health record documentation to identify reportable conditions
  • Accurately assigning ICD-10-CM codes to these conditions
  • Providers and risk adjustment professionals need to work together to ensure quality and thorough documentation of patient conditions to support risk adjustment and quality reporting initiatives. With such an emphasis on yearly code capture, provider education becomes a higher priority early in the year to prevent the loss of HCC diagnosis.
  • The NEPHO will be working to educate providers beginning early 2019 to help continue efforts to impact the patient’s health status.
  • The following coding education will be a focus for 2019:
  • Risk Adjustment Accurate Documentation and Coding Practices
  • Importance of Risk Adjustment
  • Risk Adjustment Auditing and Monitoring
  • The NEPHO will be working with providers directly to address education opportunities and to ensure accurate coding and reporting of HCCs is continued through the year. Working together can help ensure compliance and optimal financial results under HCC risk adjustment contract models.
  • Please reach out to NEPHO directly if you would like to review risk adjustment education opportunities for your practice. Contact Shawn Bromley at or call 978-236-1704.


Coding Corner - November 2018 Edition