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Medicare Coding Changes for Medical Billing in 2020

Every new year brings updates to the codes used for medical billing. Changes always include some additions for new diagnoses, procedures and technologies; revisions to make clarifications and corrections; and deletions to remove obsolete codes for treatments that are no longer accepted as part of standard care by government payers and insurers.

Medicare coding uses the Healthcare Common Procedure Coding System (HCPCS), which consists of two levels. Level I is the Current Procedural Terminology (CPT) code set that is managed by the American Medical Association (AMA). The CPT codes do not cover the many non-physician services that are commonly required by Medicare patients, so HCPCS Level II includes things like ambulance rides and durable medical equipment (DME), such as wheelchairs and oxygen tanks.

While it isn’t possible to detail all the changes in this article, the following are some of the 2020 changes that will be most important for medical billing for Medicare patients.

Transitional Care Management (TCM):  When a patient leaves the hospital, transitional care services help connect the primary care provider with the inpatient team and/or provide further service to the patient. This has been found to reduce readmission. New codes allow for services to be provided by telephone or electronically as well as in person.

Principal Care Management (PCM): Previous codes for chronic care management required tha the patient have been diagnosed with at least two chronic conditions. The new PCM codes allow for a specialist to provide care management for a single, serious condition.

E-visits: Separate new codes allow physicians and non-physician health care professionals to bill for electronic visits. The Medicare Physician Fee Schedule (PFS) for 2020 specifies that these are “patient-initiated digital communications that require a clinical decision that otherwise typically would have been provided in the office.” Patient portals have been established in compliance with HIIPA guidelines and are a usual platform for these e-visits, though other platforms are also permissible.

Self-administered Blood Pressure Monitoring:  Remote monitoring codes were included in the 2019 CPT codes, and the 2020 update adds patient-reported self-administered blood pressure monitoring. The use of remote monitoring and electronic visits are intended to improve long term care and reduce the effects of socioeconomic barriers to getting to a healthcare facility.

Opioid Use Disorder Treatment: The Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) established opioid use disorder (OUD) treatment services as a new Medicare Part B benefit. Coverage includes medications for medication-assisted treatment (MAT), but all services must be furnished by a certified opioid treatment program (OTP).

Treatment includes counseling/therapy and may also include drugs. Bundled payment rates are used, and several different ones are provided to account for different drugs used and varying clinical needs of beneficiaries.

Meningitis and Influenza Vaccines: The 2020 update includes some new codes for vaccines.

Successful medical billing depends on having the most current code set incorporated into your billing software as well as experienced medical billers who are trained on an ongoing basis to stay current. This can be an expensive endeavor for practices and medical services like labs and radiology centers.

A professional medical billing service can relieve you of that expense as well as the time and stress involved in doing your own billing. Medcare MSO’s team of experienced billers consistently gets a very high percentage of claims approved on the first submission, which greatly reduces payment times and increases revenue for our clients. Give us a call at 800-640-6409 to find out how we can help you too.