CMS Makes Late Changes to 2018 HCPCS II
- By Brad Ericson
- In AAPC News
- January 15, 2018
- 4 Comments
The Centers for Medicare & Medicaid Services (CMS) announced January changes to the 2018 HCPCS Level II code set, released in November 2017. The changes to C codes include retroactive effective dates and to several elements in G codes. The changes are below and do not show up in any publishers’ books:
| CODE | ACTION | EFF DATE | SHORT DESC | LONG DESC |
| C9488 | Change ASC Ind/ASC eff date | 4/1/2017 | ||
| C9745 | Change ASC Ind/ASC eff date | 7/1/2017 | ||
| C9746 | Change ASC Ind/ASC eff date | 7/1/2017 | ||
| C9747 | Change ASC Ind/ASC eff date | 7/1/2017 | ||
| C9748 | Change ASC Ind/ASC eff date | 1/1/2018 | ||
| G0279 | Revise Long Desc | 1/1/2018 | Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) | |
| G0499 | Add Lab Cert code 220 | 1/1/2018 | ||
| G9367 | Revise Long & Short Desc | 1/1/2018 | >= 2 same hi-rsk med ord | At least two orders for the same high-risk medication |
| G9368 | Revise Long & Short Desc | 1/1/2018 | >= 2 same hi-rsk med not ord | At least two orders for the same high-risk medications not ordered |
| G9637 | Should not have been updated – revert back to 2017 description | |||
| G9638 | Should not have been updated – revert back to 2017 description | |||
| G9868 | ADD Code | 1/1/2018 | Next Gen ACO model <10min | Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use under the Next Generation ACO model, less than 10 minutes |
| G9869 | ADD Code | 1/1/2018 | Next Gen ACO model 10-20min | Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use under the Next Generation ACO model, 10-20 minutes |
| G9870 | ADD Code | 1/1/2018 | Next Gen ACO model >20min | Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use under the Next Generation ACO model, 20 or more minutes |
| G9481 | Revise Long Desc | 1/1/2018 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved CMS innovation center demonstration project, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | |
| G9482 | Revise Long Desc | 1/1/2018 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved CMS innovation center demonstration project, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 20 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | |
| G9483 | Revise Long Desc | 1/1/2018 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved CMS innovation center demonstration project, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate severity. typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | |
| G9484 | Revise Long Desc | 1/1/2018 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved CMS innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | |
| G9485 | Revise Long Desc | 1/1/2018 | Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved CMS innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | |
| G9486 | Revise Long Desc | 1/1/2018 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved CMS innovation center demonstration project, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | |
| G9487 | Revise Long Desc | 1/1/2018 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved CMS innovation center demonstration project, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | |
| G9488 | Revise Long Desc | 1/1/2018 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved CMS innovation center demonstration project, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | |
| G9489 | Revise Long Desc | 1/1/2018 | Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved CMS innovation center demonstration project, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology | |
| G9490 | Revise Long and Short Desc | 1/1/2018 | CMMI mod home visit | CMS innovation center models, home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services. (for use only in medicare-approved CMS innovation center models); may not be billed for a 30 day period covered by a transitional care management code |
| G9890 | DELETE | |||
| G9891 | DELETE | |||
| G9989 | DO NOT ADD – Remove from previous corrections document | |||
| G9990 | DO NOT ADD – Remove from previous corrections document |
Brad Ericson
Director of Publishing at AAPC
Brad Ericson, MPC, CPC, COSC, has been director of publishing for more than 10 years. Before AAPC he was at Optum for 13 years and Aetna Health Plans prior to that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.
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It seemed that CMS chose to remove the redundancies between G9890-G9891 and G9974-G9975, but kept those in G9892-G9893 and G9976-G9977. Is a coder to distinguish the difference between AAPC sections labeled “Vision Exams” and “Vision Assessments” when the Long Descriptions are identical?
https://coder.aapc.com/hcpcs-codes-range/477
https://coder.aapc.com/hcpcs-codes-range/490
Are these changes printed some place? I am having many problems getting the G0279 paid on my claims. I have to submit documentation that the code is updated to use the new mammogram codes.
You can find them on the CMS website, but your best bet is contacting the payer.
I have multiple payers still denying the G0279 stating it wasn’t billed with the appropriate primary code. When I try to appeal or dispute, they are insistant that in the HCPC book it states to bill with G0204 and G0206 which was not on our claim. I have sent copies of CMS policies. the links to the website to view the table, and copies of the HCPC book showing the old codes are not in the book anymore. Is anyone else having this issue with insurances? Have you had any luck getting them to pay the claims? And if you have, what did you do that I haven’t? I’m just at a loss at this point.