Question: We often see patients who had surgery in St. Louis and come to us for post-operative X-rays rather than driving back for X-ray check-ups. One of our PAs recently saw a patient who falls into this scenario. The patient is still in the global period, but we are not taking over post-operative care. Can we charge an office visit or just the X-ray?

Peer into the distance and you may catch a glimpse of an entirely new way to chart your patient encounters. Over the course of the 2018 rulemaking period, CMS has laid out the preliminary groundwork that would bring its official E/M documentation guidelines full-bore into the 21st century in a shift that, while slow in the making, could mean a significant change in the way practices report — and get paid for — their most common services.

As a second-year growth spurt in the use of the chronic care management (CCM) code 99490 suggests that the code is here to stay, look to some innovations to make the service more beneficial to your patients and to your bottom line.

Take note of additional guidance on a suite of new E/M codes making their debut in 2018 after the AMA released an array of reporting limitations, billing restrictions and other updates to the CPT codes effective Jan. 1.

While you’ll find a number of benefits if you opt to participate under the Quality Payment Program (QPP) as a patient-centered medical home (PCMH), take note of some wrinkles that could change how you or your group gets graded in 2018. While you’ll face less risk, more of your sites will have to participate.