2019 CPT and HCPCS Changes: Recognizing Care You Provide Outside the Exam Room

Brett Paepke, OD

Director of ECP Services, RevolutionEHR

We’ve all heard the story of the ICD-10 fairy. As lore has it, each year she sneaks into EHR databases, adds a bunch of new codes, renames others, and even deletes a few with hopes of making our lives as doctors easier. Unfortunately, those good intentions often aren’t appreciated because 1) the changes lead to confusion and 2) they don’t produce any noticeable differences in practice. Learning the code changes, for example, doesn’t lead to increased revenue. It’s just something we need to do.

That’s not the case for changes to the Current Procedural Terminology (CPT) code set. The CPT elves visit at the same annual frequency but their gifts are often bestowed on specialties outside of our own. 2019, however, changes that through a few modifications that could impact how you bill for the care you’re providing and, in turn, your revenue. Here are four changes that can have an impact on your bottom line:

Change 1: Electroretinography (ERG)

Much like the singular OCT code was deleted a few years ago and replaced by more granular codes for the anatomical site being scanned, the traditional code for ERG, 92275, has been retired for 2019. In its place are 92273 (full field), 92274 (multifocal), and 0509T (pattern).

Change 2: Interprofessional Internet Consultations

Have you ever attempted to get insight on a case from another doctor but that doctor requests an appointment be made despite both of you knowing it could be managed effectively without a visit? Or perhaps your insight is being sought by another doctor and you request a visit. While those requests could be partially rooted in legal concern, it’s hard to ignore the idea that neither of you is being reimbursed for your time and expertise in discussion. Importantly, that doesn’t need to be the case when the visit can be avoided.

Four codes are available for the consulting doctor to use when there is both voice discussion with and a written report sent to the referring doctor. Each code is described as follows and differs only on the amount of time spent in discussion:

    Interprofessional telephone/ internet / electronic health record assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/ requesting physician or other qualified health care professional

99446: 5–10 minutes of medical consultative discussion and review (approximate reimbursement: $18)

99447: 11-20 minutes of medical consultative discussion and review (approximate reimbursement: $36)

99448: 21-30 minutes of medical consultative discussion and review (approximate reimbursement: $54)

99449: 31+ minutes of medical consultative discussion and review (approximate reimbursement: $73)

Note that each code requires a verbal and written report be provided to the referring doctor. When verbal discussion doesn’t take place, but the consultant sends a written report to the referring doctor, code 99451 can be used:

99451: Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time (approximate reimbursement: $34)

Additionally, code 99452 was added for the referring doctor to use in these cases:

99452: Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes (approximate reimbursement: $34)

Example: You’ve diagnosed a retinal hemorrhage in a patient with history of vascular occlusion and you’d like to run your thoughts by a local retinal specialist. You call the retinal specialist and share an image of the hemorrhage through secure internet technology. You spend 10 minutes in discussion and another 10 prepping for image sharing process. The specialist agrees with your assessment and your plan to re-evaluate the patient in three months. The specialist sends you a summary report of recommendations, bills the patient with code 99446, and you bill with code 99452.

Keys to remember:

  • The point of these codes is to provide reimbursement in cases that can be addressed without an office visit. If a consult starts off as electronic in nature but results in a request for the patient to be seen, that discussion is deemed included in the resulting evaluation and management service for the visit.
  • Similarly, a courtesy call to the referring doctor after a visit is not billable by either party
  • Informed patient consent is required to be documented in the medical record as copays will apply

While the Healthcare Common Procedural Coding System (HCPCS) is technically different than CPT, notable additions have also been made here for 2019:

Change 3: Remote Evaluation of Images/Video Forwarded by Patient

Today’s mobile devices can turn even the most novice shutterbug into a budding Ansel Adams. Along with those capabilities comes the opportunity for medical benefit. For example, have you ever had a patient or family member send a picture of a red eye and ask, “Is this OK?” There’s now a code for that:

G2010: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment

Keys to remember:

  • Must be initiated by patient
  • New patients, as defined by CPT, are not eligible
  • The remote evaluation must be in lieu of an office visit
  • The image/video cannot be related to a visit from the past week or lead to a visit in the immediate future
  • The billing physician must follow up with the patient within 24 hours to provide their interpretation and recommendations
  • Informed patient consent is required to be documented in the medical record as copays will apply

Approximate reimbursement: $15

Change 4: Virtual Check In

Similar in philosophy to the clinician to clinician consultations discussed earlier, there are times when communicating directly with a patient can accomplish what would have otherwise required an office visit. One example could include periodically checking in with a mild dry eye patient to ensure continued successful therapy. These types of progress checks have gone without reimbursement historically, but a 2019 change would recognize their value through a new code:

G2012: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/ M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5–10 minutes of medical discussion

Keys to remember:

  • New patients, as defined by CPT, are not eligible
  • The virtual check-in must be in lieu of an office visit
  • Audio-only, real-time telephone interaction and two-way audio interaction enhanced with video or other kinds of data transmission are all included provided there’s direct interaction between the clinician and the patient
  • The check in cannot be related to a visit from the past week or lead to a visit in the immediate future
  • Informed patient consent is required to be documented in the medical record as copays will apply

Approximate reimbursement: $15

While some of these reimbursement rates might seem modest, they are a formal attempt to start recognizing the value of our interactions with patients outside of the exam room. Thus, our awareness of coding options for these activities currently provided on a complimentary basis can be advantageous.

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