2015 Evaluation and Management Code Changes By Jackie Miller, RHIA, CCS-P, CPC he 2015 current procedural terminology (CPT) code set includes a number of new and revised codes and coding guidelines for evaluation and management (E/M) services, which are reviewed in this column. In addition to the changes in the code book, be sure to review the CPT Errata and Technical Corrections, which can be downloaded from the AMA website at www.amaassn. org/ama/pub/physician-resources/solutionsmanaging your-practice/coding-billing-insurance/cpt/abou t-cpt/errata.page. As of December 2014, there were errata related to E/M codes 99284 and 99487. The Procedure There is only one change to the E/M guidelines section of the CPT manual: “Military history” has been added as one of the topics included in the patient’s social history. The other social history topics are marital status and/or living arrangements; current employment; occupational history; use of drugs, alcohol, and tobacco; level of education; sexual history; and other relevant social factors. Pediatric Services The codes for neonatal total body systemic hypothermia (99481) and selective head hypothermia (99482), which were located in the E/M section, have been deleted. A new hypothermia code (99184) and new coding guidelines have been added to the medicine section of the CPT manual. The guidelines for inpatient neonatal and pediatric critical care (99468-99476) have been revised to clarify that the guideline for coding re-admission to the neonatal or pediatric critical care unit applies both to re-admissions on the same day and also to re-admissions during the same inpatient stay. Care Management The “Complex Chronic Care Coordination Services” section has been renamed “Care Management Services,” and it now contains two subsections: • Chronic care management (99490) • Complex chronic care management (99487, 99489) There are extensive new and revised guidelines for these codes that are beyond the scope of this article. Please carefully review the CPT manual for complete information. In order to report any of the care management codes, the organization must be able to provide “24/7 access to physicians or other qualified healthcare professionals or clinical staff.” Telling the patient to call the emergency department if problems arise does not meet this requirement. Additionally, the care management codes do not include E/M services, such as office/outpatient visits; however, on the day an E/M service is reported, the clinical staff time is included in the E/M service and cannot be counted T It is important to monitor payor bulletins for information about billing requirements and coverage for the new codes and to work with clients to ensure they understand the reporting restrictions. 32 HBMA BILLING • MARCH.APRIL.2015 CODING CORNER (continued on page 34)
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