Get to Know E/M Updates for 2008

By Suzan Berman-Hvizdash, CPC, CPC-E/M, CPC-EDS

When the Centers for Medicare and Medicaid Services (CMS) defined the term “Evaluation and Management,” they clearly indicated face-to-face contact with the patient. In this day and age, however, physicians can manage patients without face-to-face contact in several different scenarios. Because evaluation can happen without face-to-face contact, some of the new Evaluation and Management (E/M) codes have put us, CMS and other payers in a quandary.

Communication Breakdown

We now have codes for medical team conferences, online medical evaluations and an expanded telephone services section. Notice the term “evaluation” is part of the descriptor for the online service. “Evaluation and management” is also a term found in the description of the telephone service.

The codes as assigned by CPT® for these services are:

99367 Medical team conference with interdisciplinary team of health care professions, patient and/or family not present, 30 minutes or more; participation by physician

99368 …participation by non-physician qualified health care profession

99441 Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

99442 …11-20 minutes

99443 …21-30 minutes

99444 Online evaluation and management service provide by a physician to an established patient, guardian, or health care provider not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network

According to spokespeople at the CPT® symposium, CMS will not cover these services as they do not qualify under their definition of “Evaluation and Management.” There is a medical team conference code that does require patient presence for which CMS is considering coverage. That code is 99366. The discrepancy of the CMS definition is that the conference code says “patient and/or family.” If it said “patient with/without family,” it would be easier for CMS to make a more definitive decision. Other payers, such as the Blue plans, are considering these services for reimbursement.

A New Way of Doing Business

The issue now is that CPT® recognizes these types of services are taking place. The ever-changing environment of communication provides physicians, their office staffs, and their patients new tools to manage health. Patients access the web to find out more about their conditions by asking questions to online medical advisors and forming communities with others having similar conditions. The ability to communicate with physicians in this type of arena should also be a viable option for patients and their providers. Patients are already completing physician-required forms prior to visits via the internet.

A well established patient with an established condition (such as high blood pressure being controlled with medication) should have the option to communicate blood work results or changes in dosage via an electronic format (online or telephone). The decision-making process would be the same for this service as it would if the patient were sitting with the physician. The physicians would still document this service, including the decision-making component of establishing medical necessity and maybe some history, with only the exam component absent.

When looking at the medical team conference codes, it’s interesting to point out that these are also services the provider community has done for a long time. And now there are official codes representing these services (conference time codes 99361 and 99362 have been deleted); even recognizing that mid-level providers and other qualified health care professionals can participate. Coders should check with their top payers to see if these codes are considered for payment.

Revised Codes

We don’t see any major changes to the primary E/M codes for 2008; however, many are further defined. Critical care services are expanded upon regarding

which services are considered part of the critical care codes 99291 and 99292. The Pediatric Critical Care Patient Transport section and the Inpatient Neonatal and Pediatric Critical Care and Intensive Services sections are similarly defined in greater detail as well.

Case Management Services and Care Plan Oversight Services are other sections with changes to the directions/description. Also, Counseling Risk Factor Reduction and Behavior Change Intervention are revised in the introduction as well as four new codes for behavior modification.

These new CPT® codes are:

99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes

99407 …intensive, greater than 10 minutes

99408 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST) and brief intervention (SBI) services; 15 to 30 minutes

99409 …greater than 30 minutes

New E/M Code

And finally, another new code is established under the heading of “Other Evaluation and Management Services.” This code is 99477 Initial hospital care, per day, for the evaluation and management of the neonates, 28 days of age or less, who requires intensive observation, frequent interventions, and other intensive care services. There are further directions under this code as well.

With the addition of these new codes mirroring the trend in electronic technology, we look to the future with renewed confidence that CPT® will continue developing codes (and possible reimbursement opportunities) that not only keep up with new techniques in surgery, but also with the changing environment of communication, evaluation and management of health care delivery.

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