Coding and Billing

2019 Medicare Changes: What You Need to Know

By Mark Wright, OD, FCOVD,
and Carole Burns, OD, FCOVD

Dec. 5, 2018

Every year there are changes to the Medicare program. Here are the key updates to learn for next year, so your reimbursements are not compromised.

Medicare released the Final Policy, Payment and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2019. From that document, here is a summary of the changes that impact your coding for Medicare patients for 2019.

a) Elimination of the requirement to document the medical necessity of a home visit in lieu of an office visit. (Editors’ Note: Always document medical necessity when it exists for the visit or for procedures.)

b) For established patient office/outpatient visits, when relevant information is already contained in the medical record, practitioners may choose to focus their documentation on what has changed since the last visit, or on pertinent items that have not changed, and need not re-record the defined list of required elements if there is evidence that the practitioner reviewed the previous information and updated it as needed. Practitioners should still review prior data, update as necessary, and indicate in the medical record that they have done so.

c) Medicare clarified that for E/M office/outpatient visits, for new and established patients for visits, practitioners need not re-enter in the medical record information on the patient’s chief complaint and history that has already been entered by ancillary staff or the beneficiary. The practitioner may simply indicate in the medical record that he or she reviewed and verified this information.

d) Removal of potentially duplicative requirements for notations in medical records that may have previously been included in the medical records by residents or other members of the medical team for E/M visits furnished by teaching physicians.

e) CMS is finalizing proposals to pay separately for two newly defined physicians’ services furnished using communication technology:

i) Remote evaluation of recorded video and/or images submitted by an established patient (HCPCS code G2010)
• You would use this code for established patients when reviewing patient-transmitted photo or video information conducted via pre-recorded “store and forward” video or image technology to assess whether a visit is needed.

ii) Brief communication technology-based service, e.g. virtual check-in (HCPCS code G2012)
• You would use this code when the patient checks in with the practitioner via telephone or another telecommunications device to decide whether an office visit or other service is needed.

iii) CMS is finalizing policies to pay for new coding for inter-professional internet consultation (CPT codes 99446, 99447, 99448, 99449, 99451, 99452,). The final code descriptors for Inter-professional Internet Consultations are:

CPT 99446: Inter-professional telephone/internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review.

CPT 99447: Same as 99446, but 11-20 minutes of medical consultative discussion and review.

CPT 99448: Same as 99446, but 21-30 minutes of medical consultative discussion and review.

CPT 99449: Same as 99446, but 31 minutes or more of medical consultative discussion and review.

CPT 99451: Inter-professional telephone/internet/electronic health record assessment and management service provided by a consultative physician including a written report to the patient’s treating/requesting physician or other qualified health-care professional, five, or more, minutes of medical consultative time.

CPT 99452: Inter-professional telephone/internet/electronic health record referral service(s) provided by a treating/requesting physician or qualified health-care professional, 30 minutes.

f) CMS is finalizing proposals to add the following codes to the list of telehealth services:

i) HCPCS code G0513 (Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service)

ii) HCPCS code G0514 (Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code G0513 for additional 30 minutes of preventive service)

2) There are other changes to the Medicare system for 2019. These changes are:

a) Under the Affordable Care Act, the “donut hole” for prescription medicine was scheduled to close in 2020. The spending bill passed in March of this year by Congress closes the “donut hole” for brand-name drugs in 2019, and generic drugs in 2020.

b) Congress permanently repealed the cap that limited coverage on physical, speech or occupational therapy.

c) Medicare Part B annual deductible increases by $2 to $185 in 2019.

d) Medicare premiums for Parts B increases by $1.50 from $134 to $135.50 in 2019. Because premiums are based on income, those with higher incomes will pay even more (e.g.: incomes between $85,000 and $107,000 will pay $189.60). Here’s the chart for Medicare Part B premiums for 2019 (Editors’ Note: Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment and certain other medical and health services not covered by Medicare Part A.).

 

References
i. https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year
ii. https://www.cms.gov/newsroom/fact-sheets/2019-medicare-parts-b-premiums-and-deductibles

 

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