Evaluation and Management
The section contains remote-monitoring code 99091, which Medicare unbundled on Jan. 1, 2018, as well as two new codes:
• 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)
“Codes 99453 and 99454 are used to report remote physiologic monitoring services (eg, weight, blood pressure, pulse oximetry) during a 30-day period,” explains the 2019 CPT book.
Also new is the “remote physiologic monitoring treatment management services” subsection, which contains a single new code for 2019:
• 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)
“Use 99457 for time spent managing care when patients or the practice do not meet the requirements to report more specific services,” CPT explains.
You’ll find two new “interprofessional consult” codes in 2019. Medicare plans to pay for a suite of interprofessional consultation codes on Jan. 1, and CPT adds two additional codes to the suite of services. The new codes are:
• 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)
• 99452 (Interprofessional telephone/Internet/electronic health record referral service[s] provided by a treating/requesting physician or other qualified health care professional, 30 minutes)
For 2019, CMS is proposing to pay for the consultation codes that would reimburse a treating or consulting physician when collaborating on a patient’s treatment plan. The agency said in the proposed 2019 Medicare physician fee schedule that it would unbundle four current codes — 99446-99449 — that pay a consulting physician for providing a report to the treating physician in addition to the two new codes.
Gain additional clarity on physician-led chronic care management (CCM) services. When your doctor takes the lead in performing CCM services, you’ll find a separate code to report and a nice boost in revenue per claim. Since CCM code 99490 debuted, nurses and ancillary staff could perform the work behind the code. In 2019, you can report the new code – 99491 – when your doctor does the work. CPT indicates that your non-physician practitioners can also report the service under incident-to rules.
The full code description is “CCM 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."
The 2019 CPT code book describes the difference between the two codes: “Code 99490 is reported when, during the calendar month, at least 20 minutes of clinical staff time is spent in care management activities. Code 99491 is reported when 30 minutes of physician or other qualified health care professional personal time is spent in care management activities.”
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