January 16, 2019, 02:41 pm Sheri Porter – Family physicians, here's an article you can't afford to miss. It's time once again for FPM's first-of-the-year endeavor to ensure that readers are informed about Medicare coding and documentation requirements.
As always, AAFP staff experts authored the information roundup -- this year titled "The 2019 Medicare Documentation, Coding and Payment Update" and published in the journal's January/February issue.
Coauthor Kent Moore, AAFP senior strategist for physician payment, stressed the importance of that work.
"FPM provides this new information to members every year because the CPT and HCPCS (Healthcare Common Procedure Coding System) codes are updated annually. We want to ensure that family physicians are aware of changes so they're using the most current codes on their claims and getting paid appropriately for what they do," said Moore.
"Likewise, there are changes to Medicare policy that will impact Medicare payment this year. Similarly, the Quality Payment Program (QPP) is updated every year, and decisions pertaining to 2019 may impact family physicians' payment in 2021," he added.
The FPM article has a plethora of details on 2019 coding changes -- too many to run through here. The best way for physicians to receive a thorough review is to give the article a good read.
But as a teaser -- because physicians are always pumped to read about how to increase payment -- Moore picked out a couple of his top coding updates.
On the CPT side, he called out the new skin biopsy codes as particularly important. "They represent an extensive change from the previous two codes, and family physician typically do a fair amount of skin biopsies in their practices," said Moore.
Specifically, physicians now have use of skin biopsy codes 11102 through 11107 to choose from, based on whether the biopsy is tangential, punch or incisional; see the article for complete descriptions.
Notably, skin biopsy code 11100 and add-on code 11101 have been deleted.
When it came to HCPCS codes, Moore singled out the new "G" codes for virtual encounters. "These codes represent an opportunity for physicians to get paid -- at least by Medicare -- for some things they may already have been doing without reimbursement," he said.
In short, physicians now have access to
The article covers changes in Medicare documentation policy that most affect family physicians.
For instance, "For both history and exam, physicians are only required to focus their documentation on what has changed since the last visit or on pertinent items that have not changed, rather than re-documenting a defined list of required elements," wrote the authors.
A key point authors highlighted are new CPT codes 99451 and 99452 that make interprofessional consults and virtual encounters easier to bill for when they involve the care of Medicare patients.
The article also discusses the increased payment rate for chronic care management under new code 99491, a pay raise, said the authors, that "reflects the fact that the service is personally performed by the physician."
They also noted the one new vaccine code added for 2019 -- CPT code 90689 for influenza virus vaccine.
Authors had additional news for physicians participating in the Merit-based Incentive Payment System (MIPS) as noted in the "Key Points" box. "Accountability for the cost of care has increased slightly, along with the performance threshold (i.e., the minimum number of points a physician must earn in 2019 to avoid a negative payment adjustment in 2021)."
Lastly, authors provide an update on QPP changes and included an easy-to-digest box of information titled "The 2019 MIPS Requirements at a Glance."
They noted that "Jan. 1, 2019, marks the first year physicians participating in MIPS will see their Medicare payments adjusted, positively or negatively, based on the 2017 QPP performance year."
Family physicians, spend some quality time with this write-up and score a path to a more productive and prosperous year.