Author: Alysia Delozier, CPC
Professional Coder – Pinnacle Integrated Coding Solutions
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2019 CPT Changes-E/M Services
The biggest change and most talked about topic so far with the new 2019 CPT changes is telehealth. Home services have also been expanding in the medical field and what is considered a home and where home services may be provided has now been clearly defined
Telehealth is defined as the electronic review of a patient’s medical record, with a verbal and/or written report to the patient’s treating physician. There are additional codes that expand on the amount of time the consulting physician spent reviewing and reporting. Correct code selection depends on whether the consulting physician provides just a written report, or if the consulting physician has a verbal discussion with the treating physician. Code changes are presented in below.
- 99446 – 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; 5-10 minutes of medical consultative discussion and review.
- 99447 …11-20 minutes
- 99448 …21-30 minutes
- 99449 …31 minutes or more
- 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.
- 99452 – Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes.
Home services – “Home may be defined as a private residence, temporary lodging, or short-term accommodation (e.g., hotel, campground, hostel, or cruise ship).”
Remote monitoring – There are two new codes; one code is for the initial set up and education and the other code is for the supply of the monitoring device and the actual monitoring of the results for each 30 days.
- 99453 – Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.
- 99454 – Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
Collection, interpretation and remote monitoring of physiologic data – 99091 is the collection and interpretation of physiologic data, while 99457 is the remote monitoring of physiologic data. 99091 has been revised to state “each 30 days” and these two codes cannot be coded together.
- 99091 – Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days
- 99457 is a new code – Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.
Chronic Care Management – This is a new code and there are clear guidelines as to what constitutes chronic care management. This code can only be coded once per calendar month and the qualified healthcare professional must provide at least 30 minutes of time during the calendar month.
- 99491 – Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month, with the following required elements:
- multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient;
- chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline;
- comprehensive care plan established, implemented, revised, or monitored.