Perfect Your Procedural Expertise to Cope With 2019 CPT Code Changes

Prep for significant new E/M codes—and update your know-how with ICD-10 coding

If your New Year’s resolution includes giving yourself a professional skills upgrade, there’s no better way than to download new coding know-how from the experts. And that’s more convenient than ever to do: The AudioEducator 2019 Coding Updates Virtual Boot Camp—the most information-packed coding event of the year—is now available on demand.

What it is: This specialty-specific training program delivers the goods on CPT®, ICD-10-CM, and HCPCS coding changes for 2019—along with insider tips on how to select the most specific code, properly use modifiers, and minimize claim denials. Plus, you’ll learn how the 2019 Medicare Physician Fee Schedule Final Rule will benefit (or harm) your reimbursement efforts.

After all, when new codes blow in with the New Year, it’s imperative that you reequip your toolbox and recalibrate your coding acumen to be sure your 2019 performance will be up to snuff. Check out these top 5 areas ripe for careful study.

  1. New E/M Codes: Payment for Digital Medicine

The 2019 CPT® updates include several added, deleted, and revised Evaluation and Management (E/M) codes that are sure to impact many practices in many specialties, notes coding educator Dr. Michael Ferragamo.

The new E/M codes focus on remote patient monitoring. The idea is to better reflect how healthcare professionals use technology to connect with patients at home to gather care management and coordination data, according to the American Medical Association (AMA) Wire.

Details: The added E/M codes include: 99451 and 99452 for interprofessional telephone, Internet, and electronic health record services; 99453 and 99454 for remote monitoring of physiologic parameter(s); 99457 for remote physiologic monitoring treatment management services; and 99491 for chronic care management services.

  1. CPT v. CMS: Define ‘New’

Proper coding depends on proper categorizing of new patients versus established ones. But the definition of a “new” patient can be far from straightforward because the Centers for Medicare & Medicaid Services (CMS) and CPT® don’t always line up. 

For example: The CPT® definition of a new patient is: “… one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.” (Emphasis added.)

On the other hand, CMS’s definition , while very similar, omits “subspecialty.”

Rule of thumb: Use CPT® as a guide, but before submitting a claim, double check specific payer rules. And be sure you know how to bill for patients who, for instance, first see a general clinical cardiologist followed by a cardiologist of a different subspecialty, notes cardio coding pro Terry Fletcher.

  1. Watch for 3 Unexpected Fraud ‘Habits’

Don’t think that just because your practice never intends fraud that you’re safe from the wrath of audit agencies. In fact, conventional wisdom is full of misconceptions regarding fraud and “red flags,” says coding instructor Jeffrey Restuccio.

The proper (and obvious) steps to take to avoid fraud include: never billing for services not rendered, always billing the correct patient, and never making up a patient’s name. However, there are also many common, less obvious mistakes you and your physicians may be making that put the practice at risk without your knowing it.

Pitfalls: These common mistakes—or bad habits—according to HealthLeaders analysts, include: expired licenses, lack of proper supervision, and medical necessity assumptions.

  1. Tread Carefully When Using Modifier 59

A critical coding issue is proper use of modifier 59 to identify a distinct procedural service. CMS has been cracking down on use of this modifier—and has been scrutinizing shoulder surgery coding in particular, notes orthopedics coding expert Margie S. Vaught.

Tip: You should be especially wary of using modifier 59 when the surgeon performs more than one procedure during the same operative session and on the same shoulder, according to a CMS factsheet on modifier 59 guidelines.

  1. Stay Current on Coding Updates

The 2019 CPT® coding changes—E/M and otherwise—“reflect new technological and scientific advancements available to mainstream clinical practice, and ensure the code set can fulfill its trusted role as the health system’s common language for reporting contemporary medical procedures,” AMA President Barbara McAneny said in a statement.

Bottom line: Make sure you have a solid handle on all the latest updates—including ICD-10 diagnostic code changes— that affect your specialty so you can maximize your reimbursement this year. The 2019 Coding Updates Virtual Boot Camp can set you up to confidently report the new codes—and ensure you have the documentation to support every claim.

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

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