Part B News editors surveyed readers and interviewed experts to come up with numerous predictions of what will affect physician practices in 2018. Here's a sneak peek at one of the predictions related to new codes coming down the pike in 2018 -- and what you may expect -- with the remainder of the predictions coming in the Jan. 1, 2018, issue.
Prediction: New codes — for prolonged preventive care and behavioral health care — will see a slow adoption rate.
More than 50% of respondents to the Part B News predictions survey reported that they were “not at all likely” to use either of two types of codes, which cover prolonged preventive care (G0513, G0514) and a range of behavioral health services, including cognitive assessment (99483) and behavioral health care management (99484).
“It’s going to be the practices that are really paying attention that are even going to be aware of these,” says Holmes.
Practices may want to assess their previous billing patterns related to preventive care codes, such as the annual wellness visit (AWV) or Welcome to Medicare visit, advises Sandy Coffta. “What proportion of Medicare patients did I bill a second E/M on the same day as a preventive service?” she asks.
For practices that billed two E/Ms on the same day, you may find G0513 and G0514 serving as “a better avenue to get paid,” says Coffta. As a reminder, the prolonged preventive service codes can be attached to any of the 18 Medicare-covered preventive services that CMS pays for (PBN 11/13/17). The add-on codes cover additional time, starting in 30-minute allotments, that you spend with a patient during a preventive care episode and pay an extra $65.
But pay attention to the fine print on the codes, which require that you report the preventive care services as time-based services, notes Valerie Rock, senior manager with consultancy PYA in Atlanta. The new add-on codes “are not likely to be used or used correctly because the use of them will be difficult to implement,” says Rock.
CMS listed typical times in the final 2018 Medicare physician fee schedule for each of the 18 covered preventive care codes to which you can append the add-on codes, but that may be lost on many practices. “If the provider is unaware that the typical times are referenced in the final rule, he or she will either be applying incorrect assumptions to code for the service or will be unable to use the codes,” says Rock.
More practices expect to bill the prolonged preventive service codes in 2018 than the behavioral health codes, according to the Part B News survey. About 30% of practices said they were “somewhat likely” to report the new preventive add-on codes once eligible, and about 20% are “likely” to report them. Just about 2% of respondents said they were “highly likely” to put them to use.
“I think we’ll see a build,” says Holmes. “I don’t think it’s going to be something that will jump the first year.”