The information provided here applies to Medicare coding. Be sure to check with your Medicare Administrative Contractor (MAC) for additional information and clarification on these and other items. You should also contact your local insurance carriers to determine if private insurers follow Medicare's lead on all coding matters.
2018 Coding Update
As a new year begins, it is a good time to take a look at some of the coding and billing updates that may impact your practice. Following are a few highlights for your consideration.
Training and Management of INR
The Centers for Medicare and Medicaid Services (CMS) added a new code for the training and initiation of home INR monitoring (93792). In addition, code 93793 has been added for the payment of ongoing warfarin management. The prior management codes (99363-99364), which were not payable by most insurance carriers and were bundled into an E&M service for Medicare, have been deleted for 2018. Unlike 93793, training for initiating INR monitoring is payable on the same day as a separately identifiable E&M service. Neither 93792 nor 93793 can be reported during the time periods assigned to the chronic care management or transitional care management codes. Codes G0248-G0250, codes that are used when providing INR monitoring services for patients with mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism, are still listed as payable on the 2018 Medicare Fee Schedule.
Cognitive Assessment and Care Plan Services
Prior to 2018 there were no specific codes to report cognitive assessments and care planning. The addition of 99483 enables these services to be described, addresses the gaps in providing care, and promotes quality of care by listing required elements. Code 99483 lists 10 elements required for the code to be payable. The guidelines state that if all the requirements are not met, the provider should bill the services with an E&M code. The service is provided when a comprehensive evaluation of a new or existing patient exhibits signs and symptoms of cognitive impairment. The evaluation is required to establish or confirm a diagnosis, and to identify the etiology and severity of the condition. It includes a thorough evaluation of medical and psychosocial factors that potentially contribute to increased morbidity. The creation of a care plan is a service to the patient. Medical decision making includes current and likely progression of the disease; assessing the need of referral for rehabilitative, social, legal, financial or community based services; and, meal, transportation and other personal assistance services. This is a code that can only be billed once every 180 days.
Pulmonary Diagnostic Testing
Codes 94617 and 94618 have been added to report dyspnea. The previously used code 94620 has been deleted. Code 94617 is used to report exercise testing. Its descriptor reads, “Exercise test for bronchospasm, including pre- and post-spirometry electrocardiographic recording(s) and pulse oximetry.” It includes a number of pulmonary tests and electrocardiographic recordings. Code 94618, is used for pulmonary stress testing (e.g. six minute walk test) and includes the measurement of heart rate, oximetry and oxygen titration, when performed. This code is used to report pulmonary stress testing including measurements of heart rate, oxygen levels (when performed), oximetry and oxygen titration.
All nine previously used codes for chest x-rays have been deleted for 2018. The new codes, 71045-71048, no longer reflect specific views of a chest x-ray, but rather differentiate simply by the number of views. The new codes reflect common practice and allow for greater flexibility. Medicare will continue to penalize those who are using old fashioned hard films when taking x-rays instead of newer computer radiology technology. A modifier “FY” is required for claims using old technology. These claims will be reduced by seven percent in 2018 on the technical component of the service.
Psychiatric Collaborative Care Management Services
Psychiatric Collaborative Care Management Services were released in 2017 as “G” codes. These were deleted in 2018 and replaced by codes 99482-99494. These codes for initial and subsequent care management mirror the “G” codes. CPT chapter guideline are very helpful in use of these codes.
CMS implemented a Medicare Diabetes Prevention Program (MDPP) expanded model for 2018. The model has been tested and allows Medicare beneficiaries to access evidence-based diabetes prevention services. The goal is to lower the rate of progression of Type 2 diabetes. There are also several policy updates to MDPP. Additional supplier enrollment requirements and compliance standards have also been adopted to enhance program integrity.
There are changes to Section I50 on Heart Failure for 2018. Classifications are based on the American College of Cardiology and American Heart Association stages of heart failure. They complement and should not be confused with the New York Heart Association Classification of Heart Failure. There are inclusion terms that have been added related to ejection fraction, systolic heart failure, diastolic heart failure, and combined systolic and diastolic heart failure subcategories. Codes now distinguish right ventricular failure from end stage heart disease, and chronic and acute (or decompensated) heart disease in the adult. Cases of right heart failure and left heart failure are now differentiated.
The other significant coding update is under the Section I21 classification of Types of Myocardial Infarction (MI). The following types of MI’s are now categorized:
- MI Type 1 - Spontaneous myocardial infarction
- MI Type 2 - Myocardial infarction secondary to ischemic imbalance
- MI Type 3 - Patients who present with death from a presumed cardiac etiology but without confirmatory cardiac biomarkers being available
- MI Type 4 - Myocardial infarction associated with revascularization procedures
- MI Type 5 - MI - Associated with coronary artery bypass graft surgery (CABG)
Flu Vaccine Reminder
As a reminder, the Fluzone High-Dose (Influenza Virus Vaccine) is covered under Medicare Part B (code 90662). The code ONLY applies to patients ages 65 and older. Be sure a patient meets this requirement or your claim for the vaccine will be rejected.