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New billing codes available

SAN DIEGO - There are new codes clinicians can use to potentially maximize their reimbursement for treating certain patients, according to a speaker at the ACP Internal Medicine Meeting.

“There are a lot of new reimbursement opportunities in 2017,” said Jeannine Z. Engel, MD, FACP, general internist and associate professor at the University of Utah School of Medicine. “My recommendation is that you read about these codes ... and think about how one or two of these might fit into your current practice.”

Some of the new Current Procedural Terminology codes she mentioned are:

99487 = Complex chronic care management (first 60 minutes per calendar month);

99489 = Each additional 30-minute session involving chronic care management;

99497 = Advanced care planning (first 30-minute session); and

99498 = Each additional 30-minute session involving advanced care planning.

A new decision regarding coding, which Engel called significant, involved prolonged non-face-to-face services, which is 99358 for the first hour and 99359 for each additional 30 minutes.

“These have been in [Current Procedural Terminology] for a decade, but have not been paid. CMS said forever that these are bundled,” Engel said of these last two codes. “But this year, CMS said we’re going to pay these. [It] said we recognize there’s a lot of non-face-to-face work that’s not being reimbursed.”

She mentioned a few examples where these codes, which are stand-alone and must be single day of service, can be used.

“Hospitals can bill this, for work that they may do after a patient is discharged, or if you have a new patient coming and you have to review their records,” Engel said.

She warned that some of the information she presented is subject to the individual translation of billing offices, compliance groups and state Medicare contractors, among others, and she encouraged clinicians to check with their local group, facility or other appropriate entity.

“You shouldn’t necessarily take away that this is the law. You may have heard from your coders something different and that can be normal and that can actually be appropriate,” she said. “You need to take what I say with a big grain of salt. The rules are written vaguely, so they’re open to interpretation.”

CMS and ACP have presentations on their respective websites to assist clinicians and their staffs in making the right billing translations for them, according to Engel.

“Make sure someone in your group is familiar with the new requirements and make sure that person uses them,” she said. “[This person] doesn’t have to use them all. He or she can pick one or two that seem to fit best for your practice and patients and then be used to benefit both your patients and your bottom line.” – by Janel Miller

Reference:

Engel JZ. Session MTP 107. Outpatient coding: Do it right and get paid for what you do. Presented at: ACP Internal Medicine Meeting; March 29-April 1, 2017; San Diego.

Disclosure: Engel reports no relevant financial disclosures,