Watch the recorded webinar below…


0:03 Everyone, and welcome to Roundtable 153, Mastering the Upcoming 2023 Iam changes.
0:11 If you’ve been tracking with this roundtable from the beginning, then you’ll know that we changed a topic about a month ago.
0:17 We did that largely due to the significance of the EM changes, the … changes for the upcoming calendar year.
0:26 We thought it best to allocate today’s session to that discussion, so you guys can hit the ground running on January first and beyond.
0:34 The originally scheduled segment, selective fourth quarter Coding Clinic Review has been moved to January 17th, 2023. That will be our first roundtable of next year.
0:45 Leading today’s discussion will be Jessica Miller, …, Manager of Professional Fee Coding Services.
0:50 And Jessica is an accomplished operator and educator.
0:55 And I’m very much looking forward to hearing what she has to say.
0:59 My name is Scott …, I’m the vice president of coding education in continuous improvement besides Health, H.r.m. Division.
1:05 And it’s my pleasure to be here today as a panelist.
1:08 Some housekeeping stuff. First of all, there are no call in numbers. The format is streaming only.
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1:58 one of the handouts I included today provide instructions on downloading the webinar materials. Let’s pull that up real quick.
2:05 I suppose, if you are having a hard time downloading handouts that you wouldn’t be able to download this instruction.
2:11 So I’m on my screen here. All right, That’s the Reader’s Digest version.
2:20 Let’s make this a little bit.
2:25 Less noxious.
2:29 All right.
2:33 So, I’m not going to go through the instructions, just know that they’re on there. It says, Click the handouts pane.
2:40 On the desktop app, or icon, Click the handout that you want to access.
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2:54 So for some reason that that last stepsons the trip people up, but I’ll give it a shot.
3:00 And it’s just one more way that you can get the materials. So there you have it.
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3:24 Helps us understand if we’re hitting the mark and helps us understand if there’s anything we can do to help your organization.
3:28 So, thanks again, and thank you for joining us over the course of this year. Looking forward to working with you guys next year. for now. This is just to show, so I’ll go ahead and take it away. Just, I’m going to make you the presenter.
3:41 All right, Thank you so much.
3:53 Alright. Looks good. Just take it away.
3:56 Perfect. Thank you so much. So, thank you so much for joining in today. We’re gonna go through the M changes for 2023.
4:03 We’ve been anticipating them once they started working on the outpatient and office side. So, we’re gonna get into the big changes for next year.
4:16 So, why the change? That is the biggest question that everyone is asking?
4:20 So, there will only be one set of guidelines, basically, for everyone to go by instead of three.
4:27 So, prior to this implementation, we had the 95 guidelines, the 97th Guidelines, and the 2021 guidelines, so, it was hard for physicians and coders in general to, kind of, keep straight, which set of guidelines. We’re going through those.
4:42 So, they wanted to make it easier for, across the board, and, and part of that, 2021 was to, if you remember, is to decrease the burden and those physicians being able to focus on patient care.
4:55 So, the revisions were also meant to track A&M changes for 2023, planned out by Medicare.
5:02 And the importance of this highlighted was recently in the AMA Summary, if you’ve not had a chance to check out their AMA Summary, it has a lot of tips in there as well. So, make sure to check that out.
5:15 And with it being noted, the revised 2023 comprised of 20% of all allowed charges in the Medicare proposed rules, as well.
5:24 The main purpose of the documentation is to support the care of that patient via the current and future healthcare teams. These guidelines are for services that require the face-to-face encounter with the patient or the patient’s family.
5:43 So on this screen, you see now, it’s just some very high level highlights that we’re going to see, we’re going to see the total time is going to now taken into effect, your history and exam also no longer used to level those codes.
5:58 They combined both inpatient and observation care services that we’ll get into later on in the presentation, and then your discharge codes, as well.
6:08 We also had changes to prolong services and applying CPT guidelines as well.
6:16 So we’re going to cover just some of the major changes we are on a little bit of a time, and there were a lot.
6:22 So you’ll see throughout the presentation, we’re just going to give the high level for each area and the ones that had the most impact.
6:32 So the first area we wanted to talk about was the number and complexity of problems addressed at the encounter.
6:40 So this was an update to make things a little bit clearer. The specific inpatient and outpatient settings offered that complexity of care that’s given in these locations.
6:50 So the treatment required is going to be at your delivered at your inpatient observation.
6:56 The patients are going to be changing, status is a lot.
7:00 So you’re going to want to make sure one you’re looking at that care that’s in there, and you’re also going to want to look at whether or not that they were stabled for your complexity.
7:13 So you have your acute, complicated illness or injury requiring hospital inpatient or observation of care.
7:20 This can be a recent or a short-term problem, but you’re going to have that low risk of morbidity for which treatment is required.
7:29 Then you also have a new one, a new nature and complexity weren’t stable on acute illness. This is a problem that is newer recent for which treatment has already been initiated.
7:42 The patient is going to improve, while resolution may not be complete. They are stable on that aspect.
7:54 So, changes to the MDM table, physicians will now select codes based on their total time for the care of the patient or their level of medical decision making.
8:05 That’s not new for the 2021 guidelines, But it is new now in the hospital.
8:10 So, they’ve added that one acute, stable, one unstable acute illness.
8:16 one acute, uncomplicated or injure, illness or injury, requiring hospital inpatient or observation level that is going to have your low medical decision making elements on there.
8:29 They have added a new decisions added decisions for escalating to hospital level of care, impair rental, controlled substances to the high level medical decision making in your risk categories.
8:44 We also saw multiple Morbidities requiring intensive care, but this only applies to your initial nursing facility visits, You will not see, or use that in your inpatient setting.
8:58 We also found an independent historian update.
9:03 So the independent historian seems to still cause a little bit of confusion.
9:08 That is when they’re going to an outside person, other than that patient, to obtain that history.
9:15 They did include the piece that it is not, including your translation services, because all your translators are doing is translating what the patient is saying, so that is still going to be considered coming from that patient.
9:34 So, you’re acute on chronic injury or illness that poses a threat or bodily function.
9:40 We will see work up’s trying to rule out probable diagnosis is during this time.
9:46 And while the probable diagnosis may not be the final diagnosis, it does not negate or remove that work and complexity to rule out that medical decision making.
9:58 Also, on this, some of those symptoms may represent a condition that is significantly probable and still could pose that bodil potential life to life or bodily function.
10:17 So, we have some more areas here that were kind of some changes on here.
10:20 So, sending chart notes or written exchanges that are within the progress now does not qualify or meet the discussion, requires an interactive change.
10:32 The discussion does not have to be on the date of the encounter, but it is counted only once and it was used during the medical decision making.
10:41 So, a lot of time, in basket messaging is used, if you’re on Epic, for example, that does not count as meeting that requirement for the discussions regarding an interactive change.
10:52 It doesn’t need to be in person, but it does need to be initiated within a short period of time.
10:59 There is a note in the AMA Summary that does say they are stating that short period of time to be within a day or two.
11:09 We also talked about test. So the tests are considered imaging, laboratory, psychometric, or psychological data, or a clinical panel.
11:19 Now, the differentiation between the single tests and the multiple tests is defined by the CPT code set.
11:26 So for example, for data reviewed and analyzed, a pulse oximetry is not going to be considered a test.
11:36 You can also, if you are ordering it, you cannot count the order and the interpretation as well.
11:44 And technical can only be counted as an order. Only if there’s no contest professional component, you can count that as part of your MDM.
11:56 So the independent tests, there’s a highlighted section here that is very useful for everyone, and it’s tests that do not require that separate interpretation.
12:07 In our analyzes, part of that medical decision making do not count as an independent interpretation, but they may be counted as ordered or reviewed at that time.
12:20 So, the biggest change on the hospital side is going to be we are moving to a new versus established.
12:28 A new patient is one who has not received any professional services from a physician or other qualified healthcare professional, or another physician of the exact same specialty and sub specialty that belong to the same group, within the past three years.
12:51 This is a huge change.
12:55 Before they were acknowledging some specialties or sub specialties as being a new, this is not going to be considered new.
13:06 There’s also a piece we’ll talk about as well when we get into MPP senior nurse practitioner or physician’s assistants.
13:13 The rule of thumb, at least on the professional side, has always been to determine whether they’re new or established, is three years, and always go one day.
13:21 On that three year mark, that’s kinda where it gets a little change, depending on your payers.
13:28 Whether or not, so, the rule of thumb, at least on the professor, has always been three years and one day to go by, and that’ll be a big help.
13:36 On the next slide, I have a little bit of a decision tree, so this decision tree is from …
13:43 already, and they have some great tools updating, especially for the hospital side and it just walks you through, much like if you’ve seen a colonoscopy decision tree, how to go through that?
13:55 So, the very first question is, Have they seen or have they received any professional services from that same group or sub specialty within three years? If you answer, now, it’s a new patient.
14:08 If you’ve answered yes, they go through same specialty that does include your sub specialty, Then you go through, as well, and it walks you through whether they’re established or new.
14:20 I already have this blown up and next to my little bulletin board here in my office, as well, just because even as much as we’ve done on the pro side with new versus established, it is going to take a little bit of time to kinda get into that mindset now on the hospital side.
14:40 So we’re going to see two sets of codes. We’re going to use the set of codes when the patient is admitted or discharged on the same calendar day. That’s going to be your 992343236.
14:53 And then you’re going to see the other centers for patients who stay longer than a single calendar day, and these are going to be your CPT codes and 992213223 for the initial service.
15:06 Then you’re 99, 2 3 1 through 2, 3, 3 for a subsequent and then your discharges as well.
15:13 So, watching your admit times is going to be a huge help here. Also, your Medicare to rural tonight role will play into effect a little bit, as well, and there is some distinct rules inside of the AMA Summary in regards to when to admit them over the midnight hour and how to count that time.
15:37 So, some more changes are: time is not a descriptive component of the EM levels for the ED. Emergency department services are typically provided on a variable intensity basis. They often involved multiple encounters with several patients over an extended amount of time.
15:58 So it’s also going to be for your other purposes, for your time, for these services is total time on the date of the encounter.
16:07 So this is going to include both your face-to-face and non face-to-face.
16:13 It includes time regardless of the location of the physician or qualified healthcare provider.
16:19 It also does not include any time spent performing other separately reported services as well.
16:27 Um Those examples can be whether a patient is on or off the inpatient unit or in and out of an outpatient office That you’ll see that as well.
16:43 We add two new CPT codes for unlisted services.
16:48 So an unlisted service or and one that is unusual, variable or new may require a special report demonstrating the medical appropriateness of the services.
16:59 Pertinent information should include an adequate definition or description of the nature, the extent, and need for the procedure.
17:10 You also need to document the time, effort, equipment necessary to provide the service.
17:16 Additional items may include complexity of symptoms, your final diagnosis, pertinent physical findings, diagnostic and therapeutic procedures, and concurrent problems, and follow-up care.
17:31 So your first one is for a preventative medicine.
17:36 Then your Unleashed, An evaluation is going to be for anything in the outpatient setting that’s not consider preventive preventative or in the hospital setting.
17:49 So, we have some deletions of codes as well. So, we can see here, all of our observation codes are gone.
17:55 now that we’ve combined that with our inpatient, our console codes, for both outpatients other outpatient setting and our inpatient So or 9 9, 2, 4, 1, and 2 5, 1 or both done as well.
18:09 They also deleted your nursing facility services in your 99318.
18:16 We also saw deletions in our Dawson, Larry, at rest home, or boarding home.
18:21 We saw a deletion of home or resident services and then we saw some changes in our prolongs service codes as well that we’ll cover towards the end of the presentation.
18:36 All right, so on the screen, we kinda walk through where we’re talking about for our observation. So our observation discharge code is gone. That is now going to be whether they are over 30 minutes, or under 30 minutes, and based on your discharge codes, and 99238 into 3 9.
18:56 We also saw the initial observation care codes deleted, You’re going to look at that now based on your new versus established patient, then the appropriate CPT code.
19:08 We also saw the deletion of the subsequent that’s also going to fall into the appropriate subsequent hospital codes.
19:24 So, the following codes are used to report initial and subsequent evaluation and management services provided to hospital inpatients and to patients designated as hospital outpatient or your observation status.
19:38 Hospital inpatient or observation codes are used to going to be used to also report your partial hospitalization services.
19:47 So, with this, if you’re admitting same day, you’re gonna go to those 9, 2, 3, 4, 5, or six codes.
19:56 If the total time on the date of the encounter is by calendar date.
20:01 So, if your medical decision making in your total time for the code selection, a continuous service is going to spanned two calendar dates. That is a single service and is reported as one calendar date.
20:17 If this service is continuous, and it starts before and through midnight, all of that time may be applied to your reported data service.
20:30 If a patient is admitted to the hospital as an inpatient or observation status during another service, such as ED, you may want to look at your modifier 25 on that other A&M service.
20:50 For a patient admitted, and discharged from the hospital inpatient or observation status on the same day, we’re not going to report those codes for the purpose of the initial inpatient or observations during this age.
21:07 Transition from observation to inpatient will not constitute a new stay.
21:14 So that is going to be a change, as well, that we’re going to want to look at, and the console reports as well.
21:24 On the Console, Close reports, the subsequent.
21:27 So, when you have a consultant in your practice, or in your hospital setting, and that consultant person is going to, is going to be reporting those subsequent inpatient or observation dates for that second service on the same date.
21:48 So an initial service may be reported when a patient has not received any services from the physician or qualified health care provider of the same specialty or sub specialty, which we talked about who belonged to that same group.
22:02 When a nurse practitioner or an advanced practice nurses or physician’s assistants are working with physicians, they are considered the same specialty and sub specialty as that physician That’s going to be critical to watch for rounding.
22:22 Especially when the physician does the initial on, they send their PA’s through. The PA’s will no longer be considered their own specialty. They will be considered the same specialty or sub specialty.
22:37 If you have an admission of services for neonates, which is 28 days or younger, requiring intensive observation with frequent interventions or other intensive care, you’re not going to use these codes. Either. you’re gonna want to take a look at the 99 477.
22:57 We also saw from prolongs Services on our level three visit for services 90 minutes or longer. You would use the new prolongs Services Code of 9 9 3 X.
23:09 We will talk about some of the, the prolong services changes later on in the presentation as well.
23:18 First CPT code, 99233 when total time is used. We’re also going to have a Prolonged Services on there of the 9 9 3 exo.
23:28 And that will start at 65 minutes In order to use I’m sorry, starts at 50 minutes or exceeded. And so you want to go ahead for services 65 minutes or longer is when you’re going to use that prolongs services code.
23:53 So, the CPT codes are for your same day admissions and observation care, codes were acquired two or more counters on the same date, Which one of these encounters is an initial and the other encounter will be the discharge encounter.
24:08 For a patient admitted and discharged at the same encounter, that’s going to be considered one encounter, you’re going to see the 9 9, 2, 2, 1 through 2 to 3 You are not going to report the discharges with a 99221222 or 2 to 3.
24:29 For a discharge services provided to newborns, admitted and discharged on the same date, you are going to use the 99463.
24:43 So, talking a little bit more about discharges.
24:46 Here’s where our codes and the discharges are used by physician or other qualified healthcare professional. who is responsible for discharging services by other physicians or other. Healthcare providers may include instructions to the patient.
25:03 Patient’s family, patients, caregiver, and co-ordination of post discharge services may be reported with that subsequent hospital visits. So, you’re 9, 9, 2, 3, 1, 2, 3, 2, or 2, 3, 3.
25:25 So we’re going to talk about consultations. So, on the right-hand side of the screen, you will see all of the consultations have been updated. We can see with the minutes have been added, much like they were on other time based codes.
25:42 You can see for your level one, you’re gonna have the 20 minutes on your level two, you’re going to have 30 minutes, 40 minutes and 50 minutes. When that total time on the date encounter for code selections, 55 minutes must be met or exceeded.
26:05 For 17 minutes or longer, you would use the 9, 9, or 1 7 important thing to note here about consultations.
26:16 So, services that constitute a transfer of care.
26:20 For example, services that are provided for management of a patient’s entire care or care of a specific condition or problem, are reported with the appropriate, new, or established patient codes for office or other outpatient visits, home or resident services.
26:42 follow-up visits in a consultations, office, or other outpatient facility that are initiated by a consultant or a patient, or patients are reported by using the codes for established patients in the office or home of residents.
27:01 The codes may be used to report consultations that are provided in the office or outpatient, including home, or residence, or the ED.
27:12 Also, you cannot use a consultation code that is not requested by a physician.
27:21 If it is or initiated by a patient, a patient, family, and that is not going to be a consultation.
27:29 If the consultation is mandated, though, by your third party payer, that is going to require that modifier 32 as well.
27:39 We also saw that deletion of that level 199241.
27:46 So, let’s talk about consultations now in the inpatient setting.
27:52 So these consultations are provided in the hospital inpatient, or observation level patients, residents of nursing facilities, or patients in a hospital setting.
28:03 That’s …, consultation services, during the same admission, are reported using subsequent inpatient or observation KARE codes.
28:16 For example, if you have the prolonged services on an inpatient or observation consultation, you will use the 9 9 3 X O code as well.
28:29 Another big change is they are only allowing one consultation per consultant per admission.
28:39 Your new versus established will also fall into this for the same specialty and sub specialty as well.
28:49 On the next slide, I have the breakdown.
28:52 So, here’s your breakdown for if you’re using time based, So your time based starts at 35 minutes, must be made it in order to meet that 99252.
29:02 From there, it goes to 45 minutes, 60 minutes, and 80 minutes.
29:08 Now, you do also see the changes in the verbiage for the new versus established, which require a medically appropriate history, an exam.
29:19 So, while it’s not used for the medical decision making, they still need it, too.
29:25 Do that medically appropriate decisions to help treat your patients, especially with conditions that they’re trying to rule out.
29:35 You’ll also see that your medical decision making will say: Straightforward, medical decision making, low level, moderate level, and high level.
29:46 Each one of the CPT code changes and descriptions do have all of that in there, and you can determine which is what is new based on your star and your blue triangles in your CPT books.
30:04 An emergency department is defined as an organized, hospital based facility for provision of un scheduled episodic services to patients who prevent prove present, or immediate medical attention.
30:21 The facility must be available 24 hours a day.
30:26 Critical care and emergency department services may both be reported on the same day, when, after the completion of Emergency department service, the condition of the patient changes and critical care services are provided.
30:42 Time is not a descriptive component of the emergency levels of the NM service because of that variable intensity basis.
30:53 So, we do see here that there is no distinction as well, in your ED, between that new and established.
31:03 So, when our emergency room department, we see the breakdowns here for the presence, of your Level one will be an emergency room for the evaluation and management of a patient that may not require the presence of a physician or qualified health care provider.
31:21 Starting on your Level two, that is when we see that that medically appropriate history and exam in your straightforward medical decision making.
31:32 Your level three is going to require the same for the history and examination and have that low level, based on your new MDM charts, as well as the moderate and level medical decision making in your high level.
31:55 So other emergency services.
31:59 So this C P C CPT code is used, indirect emergency care, Advanced life support, the physician or other healthcare provider is located within the hospital emergency or critical care department.
32:14 Elysian, two way, voice, communication, so the direction of our performance of unnecessary medical procedures is not limited to, you’re going to have your cardiac and pulmonary resuscitation could be underneath this, Your endo tracheal …, bod yn are of airway incubation, administration of IV fluids or intra-muscular drugs, exam, your injections, electrocardiograph versions of arrhythmia, these are all services that are going to fall into this. They are doing them at the direction of EMS, emergency care, and life support.
33:03 Do we have any questions so far, Scott?
33:11 Let me see just what we’ve got here.
33:17 Means.
33:21 Here, it’s not easy to use.
33:31 Could continue with your next talk, now, trying to queue up the perfect.
33:36 All right, so we’re going to talk about prolongs services. This is where we saw a lot of change as well.
33:42 So … services or CPT code, specify location, provider of service, and weather services were on the same date or another date and face-to-face emergency room.
33:56 So one thing that we saw here was, CMS does not agree with the AMA regarding the use of Prolongs Services codes.
34:04 So your prolong service codes of 9 9, 3 5 8, re 5, 9, 99415, and 46 have new guidelines. Then, the 99417, has also been advised or revised.
34:20 CMS instead proposed its own prolongs Services codes, so for your initial inpatient, or observation prolong service code, it’s going to be G X X X one.
34:36 And for your subsequent visit, or same day is going to be the G X X X two.
34:43 Then if they’re in A home or residence visits for new, and establish is going to be a G X X three.
34:52 So on this slide, you can see that your setting is determining whether or not you’re based on your setting, your direct contact, whether it was face-to-face, and your time, as well, and then you’re non face-to-face.
35:07 So, for your 9, 9, 3, 5, 8, and 3 5 9, those are going to be used in your outpatient inpatient, or observation status setting.
35:17 Your add-on codes of the 4 1, 5, 406.
35:22 That’s going to be in your outpatient, as well as the 407, but then your 4 1 8 is going to be inpatient, observation and facility.
35:31 The next question to look at then, is your direct contact face-to-face with the patient, or face-to-face, same day, with the patient, and then you have your time in there, as well.
35:43 You will not use these codes if they are less than 15 minute increments.
35:50 There’s also no distinction, whether they’re new versus establish, or initial, or subsequent, either.
35:57 This does include your non face-to-face time, as well.
36:05 So, just.
36:08 Yes.
36:09 Yes, I was able to pull up some of the questions here.
36:13 OK, sorry guys, for Clunking through that, I’ll just go through them pretty quickly.
36:22 We have a comment that says, one of the best changes CPT ever made. In my opinion, we’re streamlining and narrowing down to a single set of guidelines.
36:29 I agree that best news of the day for, for context, like, I’m not appropriate. I’m like listening to this.
36:39 Um, it’s It’s crazy.
36:43 We have A question here.
36:46 It says, Jessica, on the big change for new versus established. What, if, in, or to provider?
36:53 What if worker provider, and then a hand surgeon who gets his hand specialty certification? Will he, or, she be able to see those patients as new that are referred to him?
37:03 Know, if they are part of the same practice in the same group, now, they’re going to your sub specialty, and your specialties are if they belong to the same group, they will not be a new patient.
37:14 OK, I hope that answers that question, a couple of questions about not being able to hear. Again, we have a large number of attendees on these. and goto Webinar kind of forces us into the streaming format.
37:29 Means we can’t provide column lines, so it’s no, that’s the trade off there.
37:34 All right, if a patient is admitted to observation by a provider, but then seen by a cardiologist.
37:41 No console, does the cardiologist bill an observation code or …?
37:46 So the patient is admitted to observation via provider.
37:49 Then seen by a cardiologist, does the cardiologist built an observation code, were Iam 992023992, and five. So I’m the worst. It’s gonna depend if a consultation order was written or why they’re seeing that provider. And, I believe on the slide, it’s, he said, if they’re the consulting provider, they will get one console. During the admission, then everything else is going to be that subsequent.
38:18 Hope that answers your question, Laurie.
38:21 Is there an updated list for the risk of complications and or morbidity, or mortality like in the 95 guidelines examples?
38:29 Yes, there is a new MDM table. Um, it is out on AMA.
38:34 And, Scott, I can get that and, if you want, we can e-mail it out to anybody or they can reach out to me and I can send it to them as well. Yeah.
38:42 What, what we’ll do just as well, we’ll include a link to that or the document itself in our, thanks for attending e-mail.
38:52 Yep. Absolutely.
38:53 I’m making myself a note right now so we don’t forget we’ll make sure that we get that out to you.
38:59 Good questions with the 99288 would Upend the modifier 25 onto the ear now?
39:06 Correct, That’s a question.
39:09 So, that was one of the questions I had as well yesterday. I went to a last minute presentation, that’s an update with some health care providers. And we did not get a straight answer on that If that is going to hit any sort of CCI edit. And I have been testing it all day to see if it comes up. It is not hitting yet in my edits As soon as we have an answer on that.
39:35 I will do if you want to reach out to me, give me about a week. We should have an update on that, and I can get that out to you.
39:42 Jessica, you want to just put out your e-mail real quick?
39:47 Just in case anyone wants to reach out to you directly.
39:51 All, actually, we got just a couple more slides on.
39:58 Whoa.
39:59 This is my direct e-mail.
40:02 Feel free to e-mail me with any questions at all.
40:11 And I’ll even.
40:16 That is my cell phone number as well. If it’s easier for you to shoot me a text, if you’re in a meeting, and you’re like, hey, we really have a question, feel free to text or fahmy. If you text me, just make sure you say who it is. So I don’t accidentally market with our i-phones new updates. You can mark spam or junk and I would hate to do that to anybody. And same thing with your e-mail in your subject line, put that you are at the roundtable. So I know that it’s a legitimate e-mail in case you fall into my spam or junk e-mail.
40:50 Very generous of you, Jess.
40:53 one last question on Prolongs services. Does face-to-face excluded telehealth visit?
41:05 You gotta talk about that one.
41:06 Technically, yes, because you’re providing that service are ready.
41:15 So with the tele health prolonged yes, there is a another code you can use. They did not have anything in the new update about telehealth in general.
41:28 I would say that’s going to default back to our 2021 guidelines for now, and as soon as we start seeing more of that time build, now, on the hospital side, we’ll see that, but then they do give that face-to-face guideline, as well, In that summary, I believe it was page 7 or 10.
41:52 Or just, that’s, um, that’s it for the questions. I’ll turn it back over to you and put myself on mute.
41:59 So the other thing, too, I know, Scott, you said something people couldn’t hear, just a helpful tip. Sometimes your drivers might need to be updated, There’s a place just before you login to Scott’s roundtables that’ll say, test your audio and sound. If you test that, it’ll pop up if you need to update that driver.
42:20 And sometimes that will help with the sound, and sometimes it meets you as you first come in. Your sound to double-check your sound on your computer as well. But if you test it, it will tell you if your driver needs to be updated.
42:35 Excellent.
42:38 OK, so we’ve got just a few more slides here to go through and then we can open it up if anybody has any additional questions.
42:48 So far prolong services and evaluation on the date of an outpatient service. That is why we saw that deletion of the 993-5455.
43:00 You are going to use the 99417 for the inpatient, or observation, or nursing facility, you’re going to use the 993 X O and for the non face-to-face time.
43:20 And you see CPT code 99358359 are used for non face-to-face time.
43:29 So, and that is on any given day for the prolong services.
43:33 Remember that prolongs services less than 15 minutes beyond the first hour or less than 15 minutes.
43:40 Beyond the final 30 minutes are not reported separately.
43:46 So Code 9, 3 5 8 is used only once per day, then your prolongs services.
43:54 It may be used to that to report the final 15 or 30 minutes on at any given date, as well.
44:06 So your, you know, 9415, that is going to be for your evaluation and management services provided in the office or outpatient setting That involves prolonged, clinical, face-to-face time with the patient, family, or caregiver.
44:25 You’re going to use that code in the …
44:29 4 1 5 with your or 200 and choose 2 or 32042, oh, 5 to 12 to 13, 14, and 15.
44:40 And your starting point for the 900 to 405 is 30 minutes beyond the typical clinical staff or an ongoing assessment of a patient in the office.
44:51 And you also have that time spent by a clinical staff on the date that is not continuous. You can still report these codes of 99415416.
45:04 Facilities may not report these two codes.
45:07 You’re also not going to report these codes in conjunction with the 9 9 or 1 7.
45:16 So here we’re going to see the total without that face-to-face contact and how it’s done. You’re not gonna report these codes in for care oversight planning.
45:28 You’re not or chronic care management by a physician, your principal care management. You’re not going to report them for medical team conferences. You’re out patient INR monitoring, your intra professional or electronic health records, consultations, or phone or Internet. So this prolonged services here, the 9 9, 3, 5 8, would not be used for that either.
45:54 It’s also not going to be used for your online digital, or management services, either.
46:01 So those were the big changes and the oversight of those and the overviews that we saw.
46:09 We did see, multiple, like I said, changes, and there is a lot.
46:13 It is done to kind of streamline everything that we see, and just to kinda touch, base on nursing facility.
46:23 So, nursing facilities also had some additional changes, and they are also outlined in the AMA Summary. So, for the nursing percent, there are two major sub categories for nursing facilities are being recognized.
46:43 Your initial nursing care facility and subsequent, both are applying to new versus established.
46:50 This does include your skilled nursing care facilities that are reported with those codes, as well.
46:58 When selecting an MDM for nursing facility services, the number and complexity of problems addressed at the encounter is considered.
47:08 For determination of a high MDM specific to initial nursing care facilities by a principal physician, it will is recognized.
47:18 You will see this is going to come into play with that multiple morbidities.
47:22 We touch base on earlier, requiring intensive care, a set of conditions, syndromes, or functional impairment that are likely to require frequent medication changes or other treatment changes and re-evaluations.
47:38 This patient would be at significant risk for worsening medical, or include end, including behavioral status and risk for re-admission into a hospital.
47:51 Then we saw some new updates to there, levels, as well, including that time.
47:59 You also saw the examination of history, inappropriate examination, and straight level, medical decision making, you’re low, moderate, and high.
48:09 There is also the same definition changes with your subsequent facility, subsequent facility as well, then your nursing home facility discharges, you’ve got your 99315, which is your 30 minutes or less.
48:26 Or your 99316, which is third over 30 minutes, on the date of the encounter.
48:32 They also saw that deletion of the 99318, The rule is to report that 7608, 309 or 3, 10.
48:47 Or prolonged. We see, we went through that.
48:52 All right, so Scott, it looks like we got roughly nine minutes left.
48:58 Are there any additional questions?
49:02 Oh, let’s go check ’em.
49:05 Pick up where we left off.
49:12 Alright.
49:16 Are a couple of questions. What about 90837 standalone psychotherapy code? Can you add 9, 9, 4 1 8 for each additional 15 minutes beyond 60 minutes?
49:30 And that was Code 9 9 3 oh 890837 standalone psychotherapy code. Can you add 99418 for each additional 15 minutes beyond 60 minutes?
49:43 It does state that does go in regards to behavioral as well.
49:53 Can you provide the Prolongs Services codes, again, used by CMS?
49:58 Yep. There’s prolong services.
50:00 Codes are G, X X, X one.
50:06 Then X two and X three.
50:13 If a … has done it in the patient is seen by different cardiac sub specialties, general cardio, ETS, interventional cardiothoracic.
50:22 Does this build as one initial consult? Followed by subsequent E and M for the other providers with modifier 25 to differentiate?
50:31 All the different sort of specialties.
50:33 Subspecialties don’t matter, so it’s not going to be a consultant, It’s going to be the first one would get the console yourself if they all belong to that same practice. It’s all going to be the subsequent.
50:48 OK.
50:53 Typically, subspecialties don’t matter anymore if they belong to the same practice.
50:59 Um, OK.
51:00 So, if anyone needs to listen back to these answers, right, we will make the recording available, and part of our, thanks for attending e-mail, Sue?
51:13 Our slides stuck on Prolongs service changes.
51:16 Yes. I think it’s the last thing you were talking about us.
51:24 Never mind. Sorry, OK.
51:29 Yeah, there’s a question was asked, I have a 2023 CPT code update webinar, not externally.
51:35 We will be providing goes that education internally to our own coders, but we’re not doing that outside of, outside of our organization.
51:45 So, that isn’t just anything else. It’s about eight minutes before the hour.
51:51 No. I was just scrolling through the AMA update that just came out to see if there’s anything on Telehealth to see if the update is in here. And it is not in here yet, either.
52:04 OK.
52:09 Alright, well, Jessica, great job, helping us navigate the world, we’re over, Vietnam.
52:17 Um, thank you everyone for attending, and for those of you that have joined multiple sessions throughout this year, thanks for that, and we hope that you stay with us next year.
52:29 Anything else, just as we close out, nothing that I have. I’ll make sure Scott, I send you over that new medical decision making table so we can send that out as well. Great, thanks Jess.
52:40 All right, Thank you, everybody, but.