Editor’s note:This is the first of two articles on Current Procedural Terminology code changes for 2019.
As the new year approaches, it’s time to look ahead to upcoming changes in Current Procedural Terminology (CPT).
Most code revisions and additions for primary care pediatrics are the continuation of changes to chronic care management, including an emphasis on digital medicine. In addition, major changes are in store for practices that provide developmental and psychological services, and there will be some changes to remote critical care service codes.
This article focuses on changes to the evaluation and management section of CPT. The second article will focus on surgical and medicine section updates, including the developmental and psychological services.
● New code
▲ Revised code
# Re-sequenced code
+ Add-on code
Underline text indicates a change.
Evaluation and management updates
An interprofessional telephone/internet/electronic health record consultation is an assessment and management service in which a patient’s treating (e.g., attending or primary) physician or other qualified health care professional (OQHCP) requests the opinion and/or treatment advice of a physician with specialty expertise (the consultant) to assist in the diagnosis and/or management of the patient’s problem without the patient’s face-to-face contact with the consultant. For the consultant:
❖ Patient may be new or established to the consultant.
❖ Patient may have a new problem or an exacerbation of an existing problem.
❖ Consultant may not have seen patient within the past 14 days.
❖ These codes are not reported if a transfer of care occurs to the consultant or other face-to-face service (e.g., surgery or hospital/office visit) is scheduled within 14 days.
❖ More than 50% of the service must be spent on the verbal or internet discussion of the patient’s condition. If more than 50% of the time is spent reviewing data or analysis, do not report these codes.
❖ Time spent is cumulative and may include time spent on data review and/or analysis, so long as that time is not the majority.
❖ Codes may be reported only once per seven days.
The descriptors for codes 99446-99449 have been revised to include communication via electronic health record.
▲99446Interprofessional telephone/Internet/electronic health record 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
▲ 9944711-20 minutes of medical consultative discussion and review
▲ 99448 21-30 minutes of medical consultative discussion and review
▲ 99449 31 minutes or more of medical consultative discussion and review
# ●99451 Interprofessional 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, 5 minutes or more of medical consultative time
Code 99452 was developed for treating physician or OQHCP services. Note the following:
❖ May report 99452 if spending 16-30 minutes in a service day preparing for the referral and/or communicating with the consultant.
❖ Do not report 99452 more than once in a 14-day period.
❖ If more than 30 minutes is spent per day, you may report the prolonged service codes (99354, 99355, 99356, 99357) for the time spent on the interprofessional telephone/internet/electronic health record discussion with the consultant (e.g., specialist) if the rules for direct prolonged services are met if the patient is face-to-face.
❖ If this service occurs when the patient is not present and the time spent in a day exceeds 30 minutes, the non-face-to-face prolonged service codes 99358, 99359 may be reported.
#● 99452 Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes
Digitally stored data services/remote physiologic monitoring
New for 2019 are codes 99453 and 99454 to report remote physiologic monitoring services (e.g., weight, blood pressure, pulse oximetry) during a 30-day period. Reporting requirements include:
❖ The device used must be a medical device as defined by the Food and Drug Administration (FDA).
❖ A physician or OQHCP must order the service.
❖ Monitoring must be provided for more than 16 days.
Do not report 99453, 99454 when these services are included in other codes for the duration of time of the physiologic monitoring service (e.g., 95250 for continuous glucose monitoring requires a minimum of 72 hours of monitoring). Code 99453 may be reported only once per episode of care.
#● 99453 Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment
#● 99454 device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
Code 99091 was revised and moved from the medicine section to the E/M section. The code now states that it is reported once per 30 days. Time spent involved with data accession, review and interpretation, modification of care plan as necessary (including communication to patient and/or caregiver), and associated documentation are included under the time for 99091.
If the services described by 99091 are provided on the same day the patient presents for an E/M service, consider them post-service work for the E/M and do not report 99091. Do not report 99091 in the same calendar month as care plan oversight services (99374, 99375, 99377, 99378, 99379, 99380), home, domiciliary or rest home care plan oversight services (99339, 99340), and remote physiologic monitoring services (99457).
Do not report 99091 if more specific codes exist. Do not report 99091 for transfer and interpretation of data from hospital or clinical laboratory computers.
# ▲99091 Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days
Remote physiologic monitoring treatment management services
These services are provided when clinical staff/physician/OQHCP uses the results of remote physiological monitoring to manage a patient under a specific treatment plan. To report remote physiological monitoring:
❖ The device used must be a medical device as defined by the FDA.
❖ A physician or OQHCP must order the service.
Code 99457 may be reported during the same service period as chronic care management services (99487, 99489, 99490), transitional care management services (99495, 99496) and behavioral health integration services (99484, 99492, 99493, 99494). Refer to CPT for other exclusions.
# ●99457 Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month
Chronic care management services
A new code was added to allow for chronic care management services that are performed by a physician or OQHCP to be reported with a unique code from clinical staff who perform the service. This code requires 30 minutes within a calendar month and may not be reported with other chronic care management services, including complex or certain care plan oversight services.
# ●99491 Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month, with the following required elements:
❖ multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient;
❖ chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline;
❖ comprehensive care plan established, implemented, revised, or monitored.
Becky Dolan contributed to this article. For coding and billing questions, email firstname.lastname@example.org.