2019 CMS MACRA Coding Changes: Heed Wording Edits & New Reporting Measures

Also new: Additional eligible clinician types and more-specific diagnosis codes

In case your head wasn’t spinning enough from all the recent 2019 ICD-10-CM and about-to-take-effect CPT® coding udpates, there are more changes in store!

In fact, as you’ll find out in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program (QPP) webinar presented by coding consultant Kim Garner-Huey, you can expect big impacts to your coding and billing procedures in 2019. Changes to the QPP and the Coding Guidelines for 2019 will give you plenty more new information to absorb.

MACRA, the law that created the QPP, makes your coding and billing work, especially in terms of ICD-10 diagnosis coding, critical to your facility’s bottom line. To do your best work, you’ll need to know the latest on MACRA coding changes, wording edits, and updates to preventive medicine measures, among other things.

To give you a head start, here’s a brief look at what you’ll need to know:

Define: ‘Associated With’ and ‘Due To’

Since the little word “with” has been causing problems for coders, the 2019 Coding Guidelines decided to help you out.

Now, when you see “with” or “in,” you should interpret these words as meaning either “associated with” or “due to”—that is, when they appear:

  • In a code title
  • In the Alphabetic Index (either under a main term or a subterm), or
  • In an instructional note in the Tabular List.

Good news: The addition of “either under a main term or a subterm” will be especially helpful for diabetes coding, as you can now assume that any condition listed underneath diabetes and with the word “with” are due to diabetes, unless the provider has stated otherwise. Less guesswork – or double-checking – for you to do!

T81.4: Get Specific

Back in the day, you could use category T81.4 to describe any surgical wound infections. Now you have more options to specify which type of infection/depth of surgical incision. They are 44X, Sepsis following a procedure, and:

Infection following a procedure

  • 40X, unspecified
  • 41X, superficial incisional surgical site
  • 42X, deep incisional surgical site
  • 43X, organ and space surgical site
  • 49X, other surgical site

Don’t worry: You have new guidance on how to use these additions. Now, you should always first use the code that identifies the infection site (if known). Then, if applicable, you can assign a code for sepsis post-procedure. And finally, use an additional code that identifies the infectious agent. This guideline applies also to codes from O86.00 to O86.03.

2019 CMS MACRA: Learn 6 New Clinician Types

On November 1, 2018, the Centers for Medicare and Medicaid Services (CMS) released the CY 2019 QPP Final Rule. (For faster reading, view the overview and executive summary here.) Now in its third year, QPP is undergoing significant changes, including but not limited to:

  • Performance threshold increased from 15 to 30 points; additional performance threshold – for exceptional performance – up to 75.
  • Addition of six new eligible clinician types.
  • Elimination of 2015 Edition CEHRT Bonus, as all practices are to now use that version.

For a quick refresher of how the Merit-based Incentive Payment System (MIPS) and QPP work, see a previous post, “2018 MIPS Sees Changes to Category Weights and Deadlines.”

2019 QPP: Report New Measures for Preventative Medicine

Remember that reporting measures is an essential component of your payment program participation. Every so often CMS evaluates which measures need to leave, and which should be added.

An example of new measures added to the 2019 QPP are those related to preventive medicine:

Urgent Care

  • 226: Tobacco Use: Screening and Cessation Intervention
  • 317: Screening for High Blood Pressure and Follow-Up Documented
  • 431: Unhealthy Alcohol Use: Screening & Brief Counseling

Skilled Nursing Facility

  • 110: Influenza Immunization
  • 317: Screening for High Blood Pressure and Follow-Up Documented

Do this: As a part of the QPP, CMS requires that you submit data for at least 6 measures for the 2018 calendar year, and one must be an outcome measure. And don’t forget you can earn bonus points by following certain steps!

The labyrinth of requirements under 2019 CMS MACRA, MIPS, and the QPP can be a confusing. Be sure to keep careful track of reporting periods, new guidelines, and rule revisions to ensure your practice is earns every deserved penny. An hour of clear instruction—thanks to Garner-Huey’s webinar “CMS MACRA and Its Impact on Coding and Billing for 2019”—can help clarity and strengthen your hold on all the required details for 2019 compliance.

To join the conference or see a replay, order a DVD or transcript, or read more

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