Don't Leave Money on the Table

FPM Offers Primer on 2018 CPT Coding Updates

January 25, 2018 04:19 pm Sheri Porter

It's a new year, and in addition to investing in a 2018 calendar, family physicians should invest a little time and energy in learning the nuances of this year's CPT coding updates. A timely article in the January/February FPM (formerly Family Practice Management) provides just the level of detail that members need.

[2018 in red ink with red marker]

The article, "Coding Changes for Family Medicine in 2018," was co-authored by two of the AAFP's foremost experts on coding issues: Kent Moore, senior strategist for physician payment, and Barbie Hays, C.P.C., coding and compliance strategist.

Together, the two deliver an easy-to-digest primer on coding updates for some of the services most likely to be handled in a family medicine clinic.

The article discusses coding for

  • cognitive assessment and care plan services,
  • psychiatric collaborative care management codes,
  • general behavioral health integration care management,
  • prolonged preventive services, and
  • anticoagulation management.

In addition, the authors cover

  • four new vaccine codes and revisions in two others;
  • five new Healthcare Common Procedure Coding System (HCPCS) modifiers to indicate patient relationship categories on claims; and
  • three new HCPCS codes that allow separate payment for the insertion, removal, and removal with reinsertion of buprenorphine subdermal implants.

Think these annual coding updates aren't important? Think again.

In an interview with AAFP News, Moore said physicians must stay updated to ensure that their claims get paid. "If you're using a code that no longer exists, then your claim is not going to get paid," he said.

Staying abreast of new coding information can also help physicians avoid potential fraud and abuse troubles.

"If the definition of a code has changed and you're billing under the old definition instead of the new one, you may be unintentionally billing incorrectly and ultimately getting paid incorrectly. That's a situation that could get you in trouble if you are audited," said Moore.

Lastly, Moore pointed out that when physicians understand annual coding updates, they are much less likely to leave money on the table.

"Sometimes new codes are created for services or new payment is attached to existing codes. If you're not billing for those things when you legitimately could be, you're shooting yourself in the foot by not claiming everything you're entitled to," said Moore.

"And that lack of knowledge can directly affect your bottom line."

Moore advised family physicians to pay particular attention to the new CPT code 99483, which enables payment for doing an assessment and developing a care plan for patients suffering from cognitive decline. The article details the 10 specific elements of service that must be provided and documented to ensure payment.

"Family physicians obviously deal with a good number of patients with cognitive impairment such as dementia or developmental issues, so it's important that they know this new code is available to capture and get paid for those services," Moore said.

Moore also pointed to the section of the article detailing coding for general behavioral health integration and care management as content readers should pay special attention to.

"We know family physicians are often the frontline when it comes to mental health and behavioral health issues, and they do a lot of care coordination related to that. Now there is a way to capture that through this other new code, 99484, and physicians should be using it," he noted.