Take note of additional guidance on a suite of new E/M codes making their debut in 2018 to describe cognitive assessment and behavioral health care, straight from this week’s AMA CPT Symposium in Chicago.
You may find the services reflected in the new codes familiar because they replace a set of HCPCS codes covering cognitive assessment (G0505) and behavioral health integration (G0502, G0503, G0504, G0507) services that you were eligible to report in 2017. However, the additional guidance, drawn from the 2018 edition of the book CPT Changes: An Insider’s View, sheds light on important billing rules that will help you stay compliant next year.
Cognitive-assessment timeline set
You’ll find a reporting threshold in the new cognitive assessment and care plan services subsection of the E/M chapter.
Specifically, you’re not eligible to report cognitive-assessment code 99483 (Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home) more than once per approximately six months – or 180 days.
That’s once per 180 days on a per-patient basis, not a per-provider basis, clarified Peter Hollman, M.D., speaking today at the 2018 AMA Symposium in Chicago.
“This [service] is a somewhat different way of looking at E/M codes,” Hollman added about the specific service elements contained in the code. The formidable reporting requirements include 10 distinct service elements that range from cognition-focused evaluation to functional assessment to evaluation for neuropsychiatric and behavioral symptoms.
Remember that, like the soon-to-be-replaced G0505 code, you will need to hit all requirements to get paid. “Ten elements, which are specified in the code, must be met in order to report this code,” the AMA states in the 2018 CPT Changes.
You will be eligible to report prolonged services codes with 99483 if your encounter runs past the 50 minutes ascribed to the cognitive-assessment code, said Hollman. Because of the heavy lifting the code requires, the relative value units (RVUs) attributed to it, at 3.44 work RVUs, are high. “This is a very significant service in terms of its valuation,” said Hollman.
For BHI services, count inpatient time as well
You can disregard guidance appearing in the 2018 CPT manual stating that time counted for behavioral health integration (BHI) services during a patient’s inpatient stay does not count, Hollmann said.
The BHI services in question include 99484 (Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month) and collaborative care management (CoCM) codes 99492-99494.
The 2018 CPT Manual contains a coding tip stating that “time spent while the patient is inpatient or admitted to observation status may not be reported” using the BHI codes.
That won’t be how the policy works in 2018, according to AMA officials. When patients are in the hospital, “you’re probably talking to the clinicians, which is an important part of the care coordination aspect,” said Hollmann. To that end, the coding tip is considered “errata” and should not be followed – and you can count behavioral care management time during a patient’s hospital stay.
Also, remember that your physician can be considered a behavioral health care manager in some cases under new CPT code rules, which may allow you to report behavioral health integration (BHI) services more easily.
For example, code 99484 specifically cites “clinical staff time.” However, new guidance from CPT says the physician can take over if needed and report the code.
“If the treating physician or other qualified health care professional personally performs behavioral health care manager activities and those activities are not used to meet the criteria for a separately reported code, his or her time may be counted toward the required behavioral health care manager time,” states the 2018 CPT manual.
The 99484 service and description appears in the new E/M subsection for general behavioral health integration care management.