How do you know you’re a coder at heart? Take this quick little quiz

Jan. 8, 2018 / By Rebecca Caux-Harry

1. You code your own doctor visits or procedures in your head during your visit, CPT and ICD.
2. When talking to friends about medical issues, you review the possible ICD codes associated.
3. Your ears perk up when you hear that the World Health Organization (WHO) has approved a new ICD-11 code for gaming disorder.
4. You think of new CPT codes like shiny new Christmas presents.
5. All of the above.

Of course, there is no wrong answer here. And while I’m curious about the coding for gaming disorder, I’ll have to wait until ICD-11 is released to use it. As an FYI, the draft code is 6D11-Gaming Disorder in the category “Mental, Behavioral and Neurodevelopmental Disorders,” subcategory “Disorders Due to Addictive Behaviors.”  It’s the new CPT codes, especially new E&M codes that capture my attention. This year we have some new E&M codes that we need to become familiar with in the Care Management category. 

99483 Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home, with all of the following required elements:

• Cognition-focused evaluation including a pertinent history and examination;
• Medical decision making of moderate or high complexity;
• Functional assessment (e.g., basic and instrumental activities of daily living), including decision-making capacity;
• Use of standardized instruments for staging of dementia (e.g., functional assessment staging test [FAST], clinical dementia rating [CDR]);
• Medication reconciliation and review for high-risk medications;
• Evaluation for neuropsychiatric and behavioral symptoms, including depression, including use of standardized screening instrument(s);
• Evaluation of safety (e.g., home), including motor vehicle operation;
• Identification of caregiver(s), caregiver knowledge, caregiver needs, social supports, and the willingness of caregiver to take on caregiving tasks;
• Development, updating or revision, or review of an Advance Care Plan;
• Creation of a written care plan, including initial plans to address any neuropsychiatric symptoms, neuro-cognitive symptoms, functional limitations, and referral to community resources as needed (e.g., rehabilitation services, adult day programs, support groups) shared with the patient and/or caregiver with initial education and support.
• Typically, 50 minutes are spent face-to-face with the patient and/or family or caregiver.

This code replaces G0505 and is reported once per 180 days. Notice that the descriptor stipulates that ALL of the bulleted items are required elements to report this code. Documentation of time alone will not satisfy the required elements of this code. This code is used when the provider is establishing a diagnosis or evaluating the severity of the patient’s condition. If documentation doesn’t contain all of the required elements, we are to use the appropriate E&M code instead. In similar fashion, we have new code 99484.

99484 Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements:

• Initial assessment or follow-up monitoring, including the use of applicable validated rating scales;
• Behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes;
• Facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation; and
• Continuity of care with a designated member of the care team.

This code replaces G0507 and has a required minimum time spent by clinical staff of 20 minutes. Additionally, it requires all of the listed elements to be performed and documented, and is reported per calendar month, as specified in the descriptor. We also have new codes 99492 for initial psychiatric collaborative care management, 99493 for subsequent psychiatric collaborative care management and add-on code 99494 initial or subsequent psychiatric collaborative care management, each additional 30 minutes. These are time-based codes, but CPT also lists required elements for each of the codes and lists the type of providers necessary for the collaborative care management. Code 99492 is reported for the first calendar month of the collaborative care, with 99493 reported for subsequent months and reported by the treating physician. Please refer to your CPT manual to read the full descriptors of these important new codes. They may pose a bit of a tracking problem for us, to insure we’re reporting correctly. But these are important services that we now have a way to report and capture the appropriate reimbursement. 

Rebecca Caux-Harry, CPC, is the CodeRyte product specialist for cardiology with 3M Health Information Systems.

Learn about changes the the IPPS code set in our archived webinar.