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.
Looking Ahead to 2017
I recently attended a meeting in Chicago where information on the new Current Procedural Terminology (CPT) codes and Medicare updates for the upcoming year were presented. Subjects covered ranged from the new modifier for telehealth services to the new codes for spine surgery. With the New Year rapidly approaching, now is the time to plan for the implementation of changes that will become effective January 1, 2017. Over the upcoming weeks, I will continue to review in detail the numerous upcoming changes to Medicare reimbursement. For your consideration, following are some preliminary observations and highlights that are of note for 2017:
- For any procedures in which the physician is both administering the sedation and performing the procedure (i.e. endoscopy, bronchoscopy, and colonoscopy), the work RVU of 0.25 will be removed from the code payment. This is in-part because so many of these procedures are being performed with an anesthesiologist providing the sedation services. If you perform just the procedure, no change is needed in your coding. You will, however, see a reduction in payment for the code. If you perform both the procedure and provide the sedation service, you will need to bill an additional code (99151-99153). These codes when billed together will result in the same payment in 2017 as in 2016, minus the adjustment for the year-to-year multiplier change. When the sedation is provided by a physician other than the one performing the procedure (not an anesthesiologist), another code set will be appropriate (99155-99157). It is important to note, gastroenterologists will need to use a unique code (G0500) for most procedures. This code is valued at 0.10 work RVUs so their affected procedures will see a decrease in payment by this amount.
- There are two new codes for health risk assessments per standardized instruments for a patient-focused and caregiver-focused assessment (96160-96061).
- Non-face-to-face prolonged service codes will be recognize for payment (99358-99359).
- New temporary care codes for payment of psychiatric collaborative care management were created. These codes are used to describe a model for providing psychiatric care in the primary care setting (G0502-G0504).
- Changes to the payment system for hospital off-campus provider-based departments (PBD) are being implemented for 2017. These changes are for new PBDs, but will also affect established PBDs that change their address or purchase new equipment.
- Complex chronic care management codes will be recognized for payment in 2017 (99487-99489). There is also a new temporary add-on code (G0506) for the comprehensive assessment of and care planning visit for patients requiring chronic care management services.
- As always, there are new codes for the latest flu vaccine. There is also a change to existing influenza virus vaccine codes that removes age references and replaces them with dosage administered differences for the codes. (90653-90658, 90674).