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Coding update 2019: CMS proposed documentation changes, introduced new codes
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WAIKOLOA, Hawaii — In the 2018 final rule, CMS proposed going to two-level codes in 2020 for new and established outpatient visits. However, because of pushback, there will be three-level codes in 2021, according to a coding update presented at Orthopedics Today Hawaii.
With the evaluation and management (E/M) coding changes, Medicare changed documentation to make it easier for orthopedic surgeons, William R. Beach, MD, said here.
“It doesn’t mean Anthem is. It doesn’t mean Cigna. It doesn’t mean Aetna is. Just Medicare basically is going to change it,” he said. “The bottom line is, if you are like me and you only do 99203 level-3 new patient visits, you are going to get a bump. If you, on the other hand, do some 99214s and not just 99203s, [then] you are kind of in the middle because the payment is going to be somewhere in the middle.”
Additionally, CMS will begin an automatic 50% reduction on E/M codes reported with -25 modifier in 2019.
Extended release triamcinolone (Zilretta, Flexion Therapeutics Inc.) now has its own HCPCS code J3304 and should be billed as 32 units per dose, Beach said. Bupivacaine liposome injectable suspension (Exparel, Pacira) also has a code.
“So, when you dictate your use of Exparel, tell them how many milligrams of it you used and you can bill for it,” Beach said.
Louis F. McIntyre, MD, said other good news from Medicare this year was the approval of a new code, 99091, for the billing and payment of telehealth and remote monitoring of patients. Providers can qualify for this code if they are involved in registry data collection and analysis. The new code is worth $58.67 per patient per month.
“Read it because it is not free money. It can’t be in a local period and it has to be 30 minutes face-to-face time,” Beach said.
McIntyre said surgeons have to follow guidelines, and everyone should be aware of the new code and should explore this for their practices.
“Data collection and registries are things that we have to do to satisfy MIPS qualifications anyway. This is going to be a larger part of our practice in the future, so something to consider,” he said.
McIntyre also said that for the shoulder, CMS had labeled 29823 as “mis-valued,” therefore the code will be re-evaluated and may lose some value this year. – by Kristine Houck, MA, ELS
Reference:
McIntyre LF, et al. Practical coding information for 2019. Presented at: Orthopedics Today Hawaii; Jan. 13-17, 2019; Waikoloa, Hawaii.
Disclosures: Beach reports he receives royalties from and is a consultant for Arthrex. McIntyre reports he receives consulting fees from Active Implants, Ceterix, Smith & Nephew and does contracted research for Rotational Medical.