Coding Changes for Family Medicine in 2018

 

New codes for cognitive assessment and care planning, team-based care management, prolonged preventive services, and anticoagulation management are among this year's changes.

Fam Pract Manag. 2018 Jan-Feb;25(1):5-8.

Author disclosures: no relevant financial affiliations disclosed.

Jan. 1 ushers in CPT code updates and a new Medicare physician fee schedule each year, and 2018 is no exception. This article provides a summary of the changes most likely to affect the way your practice gets paid.

COGNITIVE ASSESSMENT AND CARE PLAN SERVICES

A new CPT code enables payment for the in-depth assessment and care planning that is often needed for patients who are suffering from cognitive decline. Code 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,” can be billed once every 180 days per physician or qualified health professional (QHP) and requires that 10 specific elements of service are provided and documented:

  • 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 or clinical dementia rating),

  • Medication reconciliation and review for high-risk medications,

  • Evaluation for neuropsychiatric and behavioral symptoms, including depression, using a standardized screening instrument,

  • Evaluation of safety, including motor vehicle operation,

  • Identification of caregivers and their knowledge, needs, social supports, and willingness 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, neurocognitive symptoms, functional limitations, and referral to community resources as needed (e.g., rehabilitation services, adult day programs, support groups) shared with the patient, caregiver, or both, with initial education and support.

The typical time spent face-to-face with the patient, caregiver, or both is 50 minutes, according to the CPT manual. Code 99483 replaces HCPCS code G0505. Medicare's national payment allowance, not adjusted for geography, for this service in the office setting is $241.85.

KEY POINTS

  • New CPT code 99483 allows payment for cognitive assessment and care planning with a patient or caregiver.

  • Codes for team-based care management services continue to expand with the addition of several new CPT codes focused on behavioral health care management.

  • New HCPCS codes for prolonged preventive services – G0513 and G0514 – recognize that additional time is sometimes

ABOUT THE AUTHORS

show all author info

Kent Moore is senior strategist for physician payment for the American Academy of Family Physicians (AAFP) and is a contributing editor to FPM....

Barbara Hays is coding and compliance strategist for the AAFP.

Author disclosures: no relevant financial affiliations disclosed.

 
 

Copyright © 2018 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact fpmserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

MOST RECENT ISSUE


Jul-Aug 2018

Access the latest issue
of FPM journal

Read the Issue


FPM E-Newsletter

Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights."

Sign Up Now