New Year, New Codes: 5 Steps to Prepare
November 20, 2019
It’s that time of year again. As part of its annual CPT Symposium this week, the AMA released the code changes for 2020.
There are 394 code changes, including 248 new codes, 71 code deletions, and 75 code revisions. This is in addition to the 2020 ICD-10-CM codes already released – there were 273 new codes added, 30 codes revised, and 21 deleted from that code set.
ICD-10-CM code changes became effective October 1, 2019 so they should have already been integrated into the practice. But the CPT changes don’t take effect until January 1, 2020. So, how can you prepare for those? Here are 5 steps to help you hit the ground running when the new year starts.
1. Buy new books.
I’ve visited practices where staff are forced to work from outdated books – with scratched out old codes and new ones handwritten in the margins – because the practice wants to save money. Don’t let this be your practice! It’s not only the new codes that are important. It’s also the guidelines that go with them. And you won’t get those guidelines by writing new codes into an old book.
I’ve also worked with practices that provide 1 book for 6 or more people to share. When I worked as coder early in my career, I would get the new code books every year and spend an entire day highlighting and updating my notes for the year. I think it is important for each coder to do something similar – which means each person must have their own resource materials.
2. Check your sections.
Ask staff to go through the sections of CPT that affect your practice and familiarize themselves with new codes, changes, and updated or new guidelines. Make sure they also review the appendices for assistance. Here are a few tips:
1. Appendix B contains the summary of additions, deletions, and revisions for the upcoming year. This is a quick shot of where they may need to concentrate.
2. If your practice offers nerve conduction testing, Appendix J lists the sensory, motor and mixed nerves, which can help with proper coding of CPT codes 95907-95913.
3. If you work in a Cardiovascular practice that performs catheterizations and endovascular procedures, Appendix L lists the vascular families and their orders, which are necessary for proper coding of these services. There are also images of the families to help ensure proper understanding
4. Appendix P lists the codes that may be used for synchronous (live) telemedicine services, according to CPT. There is a star symbol in front of the CPT codes in the book. Be mindful of the list here, though. This is a list of codes that the AMA states are allowed for telemedicine, but the list given by CMS for telemedicine codes is different. CMS’s list of covered telemedicine services can be found HERE.
3. Get educated.
Once you have the new books, it is imperative to make sure that staff understands how to use them and apply any new or changed guidelines. Coding denials or underpayments can result if the code changes/additions aren’t utilized correctly. The AMA holds an annual CPT Symposium in Chicago where the new and changed codes are discussed by the physicians that created them. It is a great way to hear about the changes from “the horse’s mouth.” Additionally, KZA holds national, specialty-specific coding workshops each year for Orthopaedics, ENT, General Surgery and Interventional Pain.
If attending a multi-day conference is not in your budget, or if there are too many to educate to make sending everyone unfeasible, there are many webinars available that will go through the code changes. AHIMA (ahima.org), the AAPC (aapc.com), are two coding industry leaders that offer such webinars. You can check your specialty society websites to see if they hold webinars on the changes that are geared toward your area of concentration.
The AMA also has a book that is produced each year: CPT Changes: An Insider’s View. Each new or revised code is listed with detail on the new codes, guideline changes highlighted, and clinical vignettes given for the codes. This is a great resource for understanding the new and changed codes.
4. Update the practice’s coding tools.
Practices that use encounter forms will need to update them to incorporate all the code changes. If your staff uses cheat sheets (I like to call them job aids), make sure they are reviewed and updated so they are current for 2020. This includes all cheat sheets and job aids for physicians and other providers. Why is this so important? Because outdated job aids/cheat sheets/tip sheets can result in inaccurate coding and/or cost the practice money.
I was shadowing physicians in clinic, after auditing the practice. During the audit, I found that all of them had consistently misused modifier 59. So when I was onsite shadowing, I asked one of the physicians how he thought this modifier should be used. The physician pulled out a tip sheet that had been made 5 years prior, with coding bundles on it. He told me that all the physicians used this tip sheet, and it had never been updated. I explained to him how the bundles can change on a quarterly basis and subsequently created a new physician tip sheet with the updated information.
You will also want to ensure that your software vendor has the new codes loaded and ready to start being used on January 1, 2020. This includes CPT and HCOCS II codes. The 2020 ICD-10-CM codes should already be in your system and used by your staff.
5. Update your fee schedule.
Set fees for the new 2020 codes. For revised codes, understand what has been revised in the code, then evaluate whether or not the fee needs to be adjusted.
The new year can be hectic in many ways. Following these 5 steps will help you cross “getting the office coding-ready for 2020” off your list.
Author - Betty Hovey, CCS-P, CPC, CPMA, CPCD, CPB, COC, CPC-I, CDIP
Betty is a nationally recognized healthcare consultant and speaker. She is an expert auditor and loves to help practices stay compliant and profitable. Betty states, “Physicians work hard for their practices and they should be paid properly for what they do.”