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The new year brings changes to many evaluation and management codes physicians use, including chronic care management and advanced planning
What are the 2015 Current Procedural Terminology (CPT) updates that will affect our primary care practice next year?
With an estimated 264 new codes, 143 deleted codes, and 134 revised codes in 2015, now is the time to prepare.
Thankfully, most of the changes do not affect primary care physicians. However, the Evaluation and Management (E/M) section does include significant changes in advance care planning, E/M prenatal visit guidance and care management services. So let’s take a look at each of these in more detail.
Advanced care planning
The two new advanced care planning codes (99497 and 99498) are used to report the face-to-face service between a physician or other qualified healthcare professional (QHCP) and a patient, family member, or surrogate in counseling and discussing advance directives, with or without completing relevant legal forms.
As you can see, a face-to-face visit is required but doesn’t have to include the patient.
The CPT manual defines an advanced directive as, “A document appointing an agent and/or recording the wishes of a patient pertaining to his/her medical treatment at a future time should he/she lack decisional capacity at that time.”
Some examples of advance directives include:
These are time-based codes, with 99497 to be billed for the first 30 minutes, and 99498 for each additional 30 minutes. Because the purpose of the visit is the discussion, no active management of the patient’s problem(s) is performed during the time of these visits.
Additionally, these code(s) can be billed in for the following E/M services:
However, these codes cannot be billed with:
Be careful: Medicare has indicated that it will NOT pay for codes 99497 or 99498 in 2015. Check with your commercial payers to see if they are reimbursing for these codes.
E/M prenatal visit guidance
The maternity care and delivery guidelines were revised to specify the following:
NEXT PAGE: Care management services
The section title of “Complex Chronic Care Coordination” has been changed to “Care Management Services” with an addition of a new subsection, “Chronic Care Management Services” to better reflect the management services described by new code 99490.
The new code requires chronic care management services that take at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month, with the following required elements:
Medicare has announced that it will reimburse for 99490 instead of the initially-proposed G-code, and the Work Relative Value Unit (wRVU) is 0.61.
Keep in mind that chronic care management services of less than 20 minutes in a calendar month are not reported separately. The 20 minutes is in contrast to at least 60 minutes of complex chronic care management service that would be reported by a code 99487.
Also, the add-on code 99489 should not be reported for service of less than 30 minutes in addition to the first 60 minutes of complex chronic care management services during a calendar month.
According to the American Medical Association, in addition to the above criteria for care management services, the requirements for complex care management services include:
Patients may be identified by practice-specific or other published algorithms that recognize:
The answer to the reader’s question was provided by Renee Dowling, a billing and coding consultant with VEI Consulting, in Indianapolis, Indiana. Send your coding and billing questions to firstname.lastname@example.org.