Coding Changes for 2020: Don’t Miss Out

While many people make plans for a new year, it’s also time to prepare for the new 2020 Current Procedural Terminology (CPT) codes. That means reviewing CPT coding changes, learning new codes, removing deleted codes, and understanding the revised codes and definitions.

Using the right codes can help you get paid faster and prevent billing delays.

The best way to stay up-to-date with 2020 changes is to get the new CPT book CPT Changes: An Insider’s View, published annually by the American Medical Association (AMA). Appendix B summarizes the additions, deletions, and revisions.

It will definitely help you to understand the symbols in the book. A red dot indicates a new code, and a blue triangle indicates a revised code. Pay attention to the hashtag (#) symbol in front of any code; this means that the code is out of numerical sequence in the book.

(In this article, I’m providing a high-level overview of the CPT changes for 2020. It’s not a replacement for buying the book and reviewing the changes yourself.)

Key Changes in the Medicine Code Section

As medical visits and interactions online continue to gain ground, it makes sense that there are new CPT codes in the medicine section for online digital evaluation and management (E/M) services. These codes may be used by anyone who does evaluation and management services, including physicians, nurse practitioners (NPs), and physician assistants (PAs).

Medicare is recognizing these codes for payment, although the payment amounts are not high. CPT is deleting code 99444, defined as an online E/M service by a physician or other qualified healthcare professional.

One new code for 2020 is 99421, defined as: Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 5-10 minutes total.

It is a patient-initiated inquiry through a portal, so it could involve secure messaging or secure email. The question requires the physician, NP, or PA to look at the message, review the patient’s record, and respond to the patient. The practitioner then develops a plan, answers the question, orders a test, or writes a prescription that is communicated electronically to the patient.

Healthcare providers would use 99422 if the activity takes 11-20 minutes and 99423 if it takes 21 or more minutes.

These codes are for use when E/M services are performed through a HIPAA-compliant secure platform. These are for patient-initiated communications through a HIPAA-compliant secure portal, typically email or messaging through the electronic health record (EHR), and may be billed by clinicians who may independently bill an E/M service.

Here’s what this does not cover. These codes can’t be used for work done by clinicians or clinical staff who do not have E/M services in their scope of practice. For example, medical assistants or technicians typically cannot bill for this.

Also, the codes are not for use for “nonevaluative electronic communication of test results, scheduling of appointments, or other communication that does not include E/M,” as defined by the AMA’s CPT Professional 2020 Edition. Tracking cumulative time over a 7-day period will be challenging.