Jan 4, 2017 | Uncategorized
Written By: Toni Elhoms, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainern Director of Coding/Compliance Consulting ServicesnnIt’s that time of the year again! The new 2017 CPT code changes take effect January 1st. Understanding the myriad of upcoming changes is crucial to obtaining the proper reimbursement for your services! The changes for 2017 address a number of interrelated issues. Clinical practice and technology have evolved and several issues required much needed CPT expansion and clarification. CPT 2017 offers the most changes in spine and orthopedic procedures, chronic care management, physical and occupational therapy, as well as significant changes in the reporting of moderate sedation services.n*Please note, this article is not an all-inclusive list; review your 2017 CPT book for complete descriptions of all changes. Appendix B of 2017 CPT provides a summary of additions, deletions, and revisions.nnHighlights of the most significant changes:n
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- Moderate Sedation
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- Chronic Care Management
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- Flu Vaccinations
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- Spinal Instrumentation
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- Orthopedics
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- Physical and Occupational Therapy
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- Diagnostic and Interventional Radiology
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- Spinal Steroid/Epidural Injections
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Jan 4, 2017 | Uncategorized
Moderate sedation services have historically always been bundled into the majority of all applicable CPT procedures. More than 400 codes that were previously defined as including moderate sedation have been deleted from Appendix G. In addition to six new CPT codes and one new endoscopy-specific HCPCS code, CMS intends to create a “uniform methodology for valuation of the procedural codes that currently include moderate sedation as an inherent part of the procedure” with this year’s CPT updates. Providers who perform moderate sedation with a procedure must report the appropriate new moderate sedation codes to receive full reimbursement. As a result of removing this long time bundling edit, many procedures will see a slight reduction in RVU.n
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- 99151 – Moderate sedation services provided by the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age
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- 99152 – Initial 15 minutes of intraservice time, patient age 5 years or older
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- 99153 – Each additional 15 minutes intraservice time
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- 99155 – Moderate sedation services provided by the physician or other qualified health care professional other than the physician performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age
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- 99156 – Initial 15 minutes of intraservice time, patient age 5 years or older
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- 99157 – Each additional 15 minutes intraservice time
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- G0500 – Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports
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Jan 4, 2017 | Uncategorized
Effective Jan. 1st, CMS will begin paying for complex CCM services (99487-99489) in addition to normal CCM (99490). These CPT codes have been around for a while, but CMS has always refused to reimburse for them. Keep in mind, to get paid, you must be able to properly note all the moving parts of this service in the medical record as indicated by the coding guidelines.nnCMS has also created a new add-on G code — G0506 (Comprehensive assessment of and care planning for patients requiring chronic care management services [List separately in addition to primary monthly care management service]).nnIt covers the additional work associated with assessing CCM services and generating a care plan. This used to be bundled into payment for an office visit (99201-99215), but in 2017 you can get paid EXTRA for it if you nail down your documentation. You’ll also find relaxed billing rules for CCM services in 2017, which include getting rid of a beneficiary consent form and removing the requirement for 24/7 access to care.n
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Jan 4, 2017 | Uncategorized
Several new codes will replace long time spinal biomechanical device code 22851. The new codes are more specific regarding the type and location of the biomechanical devices.n
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- 22853 – Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure)
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- 22854 – Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)
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- 22859 – Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)
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nAdditional codes have been created to replace temporary codes for interspinous process decompression devices (IPD).n
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- 22867 – Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level
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- 22868 – Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; second level (List separately in addition to code for primary procedure)
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- 22869 – Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level
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- 22870 – Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; second level (List separately in addition to code for primary procedure)
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Jan 4, 2017 | Uncategorized
Influenza codes received a makeover with this year’s CPT update. The codes are no longer classified based on age. The descriptions of these codes now reflect dosage amounts. Codes now state “becomes 0.25 mL dosage” in place of “when administered to children 6-35 months of age” and “becomes 0.5 mL dosage” in place of “when administered to individuals three years and older”. These changes affect codes 90655 – 90661 and 90685 – 90688.nn
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Jan 4, 2017 | Uncategorized
Physical and occupational therapy codes received a major overhaul with this year’s CPT update. Codes have been expanded to take into account the overall evaluation complexity. The new codes incorporate a tiered level of complexity for physical and occupational therapy as well as athletic training evaluations. These new codes also require a substantial increase in the volume and quality of clinical documentation needed to capture these services compliantly.n
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- 97161 – Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with stable and/or uncomplicated characteristics; and Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 20 minutes are spent face-to-face with the patient and/or family.
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- 97162 – Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; An evolving clinical presentation with changing characteristics; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 minutes are spent face-to-face with the patient and/or family.
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- 97163 – Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with unstable and unpredictable characteristics; and Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 minutes are spent face-to-face with the patient and/or family.
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- 97164 – Re-evaluation of physical therapy established plan of care, requiring these components: An examination including a review of history and use of standardized tests and measures is required; and Revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outcome Typically, 20 minutes are spent face-to-face with the patient and/or family.
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- 97165 – Occupational therapy evaluation, low complexity, requiring these components: An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; An assessment(s) that identifies 1-3 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem-focused assessment(s), and consideration of a limited number of treatment options. Patient presents with no comorbidities that affect occupational performance. Modification of tasks or assistance (eg, physical or verbal) with assessment(s) is not necessary to enable completion of evaluation component. Typically, 30 minutes are spent face-to-face with the patient and/or family.
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- 97166 – Occupational therapy evaluation, moderate complexity, requiring these components: An occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 3-5 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment(s), and consideration of several treatment options. Patient may present with comorbidities that affect occupational performance. Minimal to moderate modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 45 minutes are spent face-to-face with the patient and/or family.
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- 97167 – Occupational therapy evaluation, high complexity, requiring these components: An occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 5 or more performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of high analytic complexity, which includes an analysis of the patient profile, analysis of data from comprehensive assessment(s), and consideration of multiple treatment options. Patient presents with comorbidities that affect occupational performance. Significant modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 60 minutes are spent face-to-face with the patient and/or family.
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- 97168 – Re-evaluation of occupational therapy established plan of care, requiring these components: An assessment of changes in patient functional or medical status with revised plan of care; An update to the initial occupational profile to reflect changes in condition or environment that affect future interventions and/or goals; and A revised plan of care. A formal reevaluation is performed when there is a documented change in functional status or a significant change to the plan of care is required. Typically, 30 minutes are spent face-to-face with the patient and/or family.
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- 97169 – Athletic training evaluation, low complexity, requiring these components: A history and physical activity profile with no comorbidities that affect physical activity; An examination of affected body area and other symptomatic or related systems addressing 1-2 elements from any of the following: body structures, physical activity, and/or participation deficiencies; and Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 15 minutes are spent face-to-face with the patient and/or family.
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- 97170 – Athletic training evaluation, moderate complexity, requiring these components: A medical history and physical activity profile with 1-2 comorbidities that affect physical activity; An examination of affected body area and other symptomatic or related systems addressing a total of 3 or more elements from any of the following: body structures, physical activity, and/or participation deficiencies; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 minutes are spent face-to-face with the patient and/or family.
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- 97171 – Athletic training evaluation, high complexity, requiring these components: A medical history and physical activity profile, with 3 or more comorbidities that affect physical activity; A comprehensive examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures, physical activity, and/or participation deficiencies; Clinical presentation with unstable and unpredictable characteristics; and Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 minutes are spent face-to-face with the patient and/or family.
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- 97172 – Re-evaluation of athletic training established plan of care requiring these components: An assessment of patient’s current functional status when there is a documented change; and A revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outcome with an update in management options, goals, and interventions. Typically, 20 minutes are spent face-to-face with the patient and/or family.
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