Brace Yourself For Cardiology Coding & Medicare Updates In 2019

Keep watch for substantial changes to E/M billing and pay rates

From CPT® and ICD-10-CM code updates, to significant revisions to Medicare guidelines, you have a lot to contend with for your cardiology practice’s coding and billing in 2019. Here are some of the most important changes that you need to know.

For 2019, you’ll face 473 ICD-10-CM and more than 150 CPT® code changes, including new, revised, and discontinued codes, according to cardiology coding expert Terry Fletcher in her 2019 Coding Updates Virtual Boot Camp for Cardiology webinar series.

Pay Attention To New ICD-10 Codes

Heads up: The 2019 ICD-10 update included 279 new codes, 143 revised codes, and 51 deleted codes. There are a multitude of code updates that will impact cardiology practices, but make sure that you don’t overlook the new codes in Chapter 2 (Neoplasm), such as:

  • 111 Malignant melanoma of right upper eyelid, including canthus
  • 112 …of right lower eyelid, including canthus

The Centers for Medicare & Medicaid Services (CMS) also added the following new code to Chapter 19 (Injury, Poisoning and Certain Other Consequences of External Causes):

  • 3 Psychological abuse, confirmed
    • Bullying and intimidation, confirmed
    • Intimidation through social media, confirmed

Crucial: The National Center for Health Statistics (NCHS) released the 2019 official guidelines for coding and reporting ICD-10-CM. Notably, the updated guidelines address the term “with” by providing some clarification language, Fletcher said. You should interpret the words “with” and “in” to mean “associated with” or “due to” when they appear in a code title, the Alphabetic Index (either under a main term or sub-term), or an instructional note in the Tabular List.

The General Guideline section has additions and revisions to code set Z55-Z65 (Social Determinant) and changes to General Guideline 19 (Coding for Healthcare Encounters in Hurricane Aftermath). You’ll also find some chapter-specific guideline updates for 2019 in the following:

  • Chapter 1 (Sepsis due to postprocedural infection);
  • Chapter 2 (Current malignancy versus personal history of malignancy);
  • Chapter 5 (Factious Disorder);
  • Chapter 9 (Hypertension with Heart Disease, Hypertensive Chronic Kidney Disease, and Subsequent Acute Myocardial Infarction);
  • Chapter 15 (Drug use during pregnancy, childbirth and the puerperium); and
  • Chapter 18 (Glascow coma scale).

Possible Revised E/M Pay Structure

Another important coding change for 2019 is CMS’ attempt to consolidate Evaluation and Management (E/M) billing. CMS aims to provide a flat rate for Level 2 through Level 5 E/M codes, instead of each code having its own pay rate. This potential change appeared in the proposed 2019 Medicare Physician Fee Schedule.

Pay: Office visits for new patients would have a reimbursement rate of $44 for Level 1 E/M services (99201) and $135 for Level 2 through Level 5 E/M services (99202 – 99205). For established patients, office visits would reimburse at $24 for Level 1 and $93 for Level 2 through 5. Under the proposed rule, CMS would allow practitioners to document office and outpatient E/M visits using medical decision-making or time, instead of applying the current 1995 or 1997 E/M documentation guidelines.

The proposal also incorporates add-on codes that you could bill to account for the added value of primary care ($5.41) or specialty care ($13.70), in addition to the blended rate, according to the American College of Cardiology. And CMS wants to create a new code for prolonged face-to-face services ($67.41).

Drawbacks: The impact on certain practices may be significant, especially those practices that typically have a larger share of Level 4 or Level 5 E/M visits. For instance, a heart failure patient seen at your practice for a Level 4 visit would still be reported as such – you just wouldn’t receive the same payment. But you can report the add-on for specialty care services and, if applicable, the prolonged face-to-face service code.

Get Ready For New Telehealth Payments

A significantly positive change is CMS’ proposal to make changes to the way it pays for telehealth. Although CMS has bundled routine non-face-to-face communication into the cost of in-person visits, the proposal would reimburse physicians for video or audio check-ins even if they don’t result in an office visit. Medicare would pay $14 per virtual check-in, compared to the cost of a $92 patient visit.

What’s more: You would be able to review photos or videos submitted by patients via prerecorded “store and forward” video or image technology to determine whether an in-person visit is necessary. CMS also seeks to allow physicians to practice telehealth without establishing a prior in-person relationship with each patient.

And finally, CMS proposes to open up new opioid and substance abuse treatment options, including virtual medication-assisted therapy, Terry Fletcher said in her webinar series.

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