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5 coding nuggets revealed at the 2020 AMA Symposium

From new online E/M services and care management codes to changes in surgical procedures and remote monitoring codes, you’ll find many code changes coming your way in 2020. Here's some of what practicing physicians, clinicians and AMA officials covered during the CPT and RBRVS 2020 Annual Symposium taking place Nov. 20-22 in Chicago:

Yes, you need consent for principal care management codes G2064 and G2065. The new codes cover 30 minutes of intense care management that may be beyond the scope of care typically covered by primary care providers with 99490. But, similar to the standing CPT codes covering CCM services, you’ll have to get patients’ buy-in.

"You need to get consent to bill. We know this is a problem, but the law requires it," said Kathy Bryant, senior technical advisor of the hospital and ambulatory group with CMS.

 "They're basically patterned after [chronic care managment codes] 99491 and 99490," said Peter Hollman, M.D., member of the AMA’s RBRVS update committee (RUC)>  "In general, the rules are the same."

However, there are key differences between the HCPCS codes and 99491-99490 -- namely, the former require one condition lasting about three months in duration and require 30 minutes of time. For PCM, like CCM, only one provider can bill per month.

Expect the AMA to align with revised CCM standards. The AMA is actively looking to align code revisions with CMS, which finalized a plan to modify the “typical care plan” within the CCM documentation requirements to provide simpler language. For instance, CMS deleted "community/social services ordered" and other related parts of the comprehensive care plan.

"The CPT panel is considering changes for 2021," Hollman said. Regarding the new CCM add-on code, G2058, that CMS finalized for reporting in 2020: "More to come from CPT in 2021," Hollman said, suggesting we can expect a CPT code.

For complex CCM, CMS deleted the "establishment or substantial revision of a comprehensive care plan" requirement.  And Hollman says: "This also went to the CPT panel as well, so you're going to have congruity coming up."

Welcome blood pressure self-monitoring codes. These services, reported with codes 99473 and 99474, are intended to give patients a way to self-assess blood pressure status, share that information with physicians and allow physicians to get paid for the assessment.

"This one, I think is going to be really helpful," said Robert Piana, M.D, a member of the CPT Editorial Panel’s executive committee. "I must do this 10 times a day -- trying to get patients to self-report."

Note that the 99473-99474 codes are different from the ambulatory monitoring done by an automated cuff system that creates its own report, such as 93784-93790.

To describe how this might work in practice, Piana said, "I can tell my patients to go to Walgreen's, get a blood pressure cuff and keep a log. That's probably good enough for most of my patients."

Watch how your payers audit your E/M claims in 2021. As it stands, you’ll be eligible to base your levels of E/M office visits on medical decision-making or time starting Jan. 1, 2021. But what if you meet different levels for the two elements and your notes show as such? For instance, what if you meet a Level 3 under MDM but a Level 4 under time?

According to officials from several Medicare administrative contractors (MACs) speaking at the conference, the payers will allow the Level 4 code to pass -- provided that’s the one that you reported on the claim.

But the situation is worth watching, because it remains to be seen how MACs and other payers will approach their reviews.

Two ligation procedure codes shift global days. Two stab phlebectomy of varicose veins codes, 37765 and 37766, downshift from their current 90-day global status to a 10-day global status starting Jan. 1, 2020. That could result in providers leaving money on the table, because they may not be aware that they can bill for post-op E/M visits after the 10-day period ends in 2020.

“Your providers won’t remember that,” said Sean Roddy, M.D., chair of the advocacy and policy council and CPT advisor for the Society for Vascular Surgery. Roddy urges coders to make a point of capturing the eligible E/M services in 2020 that they couldn’t before. As part of the global period change, the relative value units (RVU) for the codes decreased dramatically. The RVUs for 37765 will be 4.80 in 2020, down from 7.71; and those for 37766 will fall to 6.00 from 9.66.

The codes were claimed 30,184 times in 2018, mostly by general and vascular surgeons, with a denial rate of 10%.

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