General Surgery Coding Alert

Don’t miss CPT^® 2023 E/M code changes.

The rapid expansion of Medicare payment for telehealth services during COVID-19 is set to change following the public health emergency (PHE) expiration.

Our experts are here to help you understand the impact of CPT^® 2023 E/M code changes and calendar year (CY) 2023 Medicare Physician Fee Schedule (MPFS) final rule instructions to guide your general surgery practice compliance this year.

Examine Medicare’s Updated Covered Telehealth E/M List

Medicare’s original telehealth covered-service list included the following codes:

• 99217 (Observation care discharge day management …)
• 99218- 99220 (Initial observation care, per day …)
• 99224-99226 (Subsequent observation care, per day …)
• 99221-99223 (Initial hospital inpatient or observation care, per day …)
• 99231-99233 (Subsequent hospital inpatient or observation care, per day …)
• 99234- 99236 (Hospital inpatient or observation care … of a patient including admission and discharge on the same date …)
• 99238-99239 (Hospital inpatient or observation discharge day management …)

CPT^® changes: But in 2023, CPT^® deletes hospital observation codes 99218-99220, 99224-99226, and 99217. Plus, CPT^® revises the remaining codes on the list to include observation care and streamline code level selection based on level of medical decision making (MDM) or time. (See General Surgery Coding Alert Vol. 24 No. 12 “Embrace E/M Shift to Time or MDM.”)

Medicare: In the MPFS final rule, “as expected, CMS [Centers for Medicare & Medicaid Services] eliminated the observation codes mentioned above from the telehealth code list,” says Kelly Loya, CPC, CHC, CRMA, CPhT, CHIAP, associate partner at Pinnacle Enterprise Risk Consulting Services, Charlotte, North Carolina.

More: CMS also eliminated two other codes from the covered list because CPT^® deletes the codes for 2023: +99356 (Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour…) and +99357 (… each additional 30 minutes).

Instead: Two new codes describe prolonged services in 2023, the new CPT^® 2023 code +99418 (Prolonged inpatient or observation evaluation and management service(s) time ….) and HCPCS Level II code G0316 (Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service …). Consequently, Medicare adds G0316 to the 2023 telehealth list. (See General Surgery Coding Alert Vol. 24 No. 12, “Confront Agency Differences for Reporting Prolonged Services.”)

Resource: You can find the most recent approved telehealth list at www.cms.gov/Medicare/Medicare-General-Information/ Telehealth/Telehealth-Codes.

Prepare to Go Back to These Place-of-Service Codes

Under the final rule for 2023, CMS continues to allow providers to bill the place of service (POS) as if the telehealth service were furnished in person in a location such as the physician’s office. That means you do not currently need to use POS 02 (Telehealth provided other than in patient’s home) or POS 10 (Telehealth provided in patient’s home). You may continue to use a code such as POS 11 (Office) if that is where your provider would have normally performed the service in person.

Note: Despite the fact that Medicare doesn’t limit telehealth coverage to certain service locations, other restrictions may apply. For instance, practice scope or legal restrictions about rendering medical care across state lines may restrict when your surgeons can perform and bill for telehealth services.

Find out if your practice is compliant with current telehealth guidelines by going to telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/ telehealth-licensing-requirements-and-interstate-compacts/ .

Post-PHE: The final rule stipulates that when the PHE ends, providers will need to adapt to a post-COVID coding landscape. Starting on the 152nd day after the PHE concludes, providers will need to return to using POS 02 or 10, as appropriate.

Understand Audio-Only Interaction

Currently, providers can offer “certain counseling behavioral health care and educational services” as audio-only, such as 99497/+99494 (Advance care planning… first 30 minutes / each additional 30 minutes…), according to CMS. Also, physicians or other qualified healthcare professionals (QHPs) in your practice may bill 99441 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services …; 5-10 minutes of medical discussion), 99442 (… 11-20 minutes of medical discussion), or 99443 (… 21-30 minutes of medical discussion) as telephone/audio-only services. Medicare coverage of 99441-99443 expires 152nd day after the PHE concludes.

Remember: Physicians and QHPs must meet and follow current CPT^® guidelines for the services. Consult the Medicare telehealth services list for the current status of services that can be provided as audio-only.

Modifier alert: For qualifying audio-only services, you can select either Medicare modifier FQ (The service was furnished using audio-only communication technology) or CPT^® modifier 93 (Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system). Modifier FR (The supervising practitioner was present through two-way, audio/video communication technology) is also still available for use on applicable claims.

Post-PHE: “Following the 151-day post-PHE extension period, CMS will once again assign the telephone E/M services a ‘bundled’ status, which means Medicare will no longer separately pay for them,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

Know How to Keep Telehealth Sessions HIPAA Compliant

During the PHE, CMS is allowing providers to use “popular non-public facing applications that allow for video chats … without risk of penalty for noncompliance with the HIPAA Rules.” This means providers and patients can currently use such popular audio/video platforms as “Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype” for “all services on the Medicare telehealth list,” according to an FAQ published by CMS (www.cms.gov/files/ document/03092020-covid-19-faqs-508.pdf, page 74).

Watch for End Dates and Extensions

At press time, no information is available about extending the current COVID-19 PHE that expires January 11. However, the Consolidated Appropriations Act, 2022 ensures a 151-day extension period after the PHE expires before PHE policies such as telehealth coverage will end.