The Centers for Medicare and Medicaid Services (CMS) have put out the proposed rule to begin January 1, 2020. The Correct Procedural Terminology (CPT) code set is a living entity and, like any living entity, is constantly changing to external pressures. In 2020, 248 new codes, 71 deleted codes and 75 revised codes go into effect. Three changes are likely of interest to AAGL members. First, there are new codes for online visits valued by the AMA-RUC committee and accepted by CMS. Second, increased value for E&M services outside of any global packages. Third, new changes to documentation requirements—delayed until 2021. The last two issues will be the focus of future editions of “Coding Decoded”.99421, 99422 and 99423 are new codes used to describe patient-initiated online, digital evaluation and management (E&M) services. Previously, 99444 was used for online services, but CMS had never valued this code and most third-party payers did not reimburse for it. These new codes are time-based and have the following rules attached:
- The patient must be an established patient.
- The interaction cannot be 7 days before or after an in-person E&M service for the same problem (a new, different problem E&M visit does not exclude the use of this code).
- Surgeons cannot report this code during the global period.
- The interaction must be documented in the health record and must occur via HIPAA compliant platform (such as messaging within the EMR, secure email, etc.).
- The time billed includes the time to review the patient request, review the chart for any information required, the patient communication interaction and documentation.These codes can only be billed once in a 7-day period and can only include your time—not staff time.
These codes can be billed by physicians, nurse practitioners and physician assistants. If a face-to-face E&M occurs within 7 days, then the online visit work is folded into the face-to-face E&M.
The following table outlines the times and work RVU values.
|99421||Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes||0.25|
|99423||21 or more minutes||0.8|
It is encouraging to see the commitment to improving patient access to specialists for people who may not live near a MIGS specialist. For example, a patient could see a MIGS specialist for a consultation regarding their abnormal uterine bleeding. The surgeon could prescribe medical management. The patient could then follow up in three months via “digitally supported communication” that the medical management is not working and request additional information about surgical management. The surgeon could then review the chart, recommend a surgical procedure, and discuss the risks, benefits and alternatives via “digitally supported communication” (e.g., telephone). The surgeon could then schedule the patient for the procedure. As long as the first visit and the surgery were more than seven days from the patient-initiated message, then the service is a billable service. Hopefully the days of requiring a face-to-face follow-up for patients for which this would be a true hardship are gone.
Look for more information on changes to E&M values and E&M documentation requirements in future editions of “Coding Decoded”.
Dr. Hathaway welcomes your questions and comments. This information is for informational purposes only. Please consult with your billing specialist before applying this coding information to your practice.