Coding Changes for 2020: Don't Miss Out

Betsy Nicoletti, MS

Disclosures

December 11, 2019

Code 99473: Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration. This means the patient has a home blood pressure cuff, and the staff makes sure it is accurate and that the patient knows how to use it.

Code 99474: Separate self-measurements of two readings, 1 minute apart, twice daily over a 30-day period (minimum of 12 readings); collection of data reported by the patient and/or caregiver to the physician or other qualified healthcare professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient.

The code doesn't mandate the method in which the physician gets the information—it doesn't have to be digitally collected, stored, and transmitted. The patient could write down the information and send it to the physician electronically or by mail. The physician, NP, or PA looks at it and either changes or doesn't change the medication/plan.

Code 99473 is used when a patient brings in their home blood pressure cuff/monitor, it is calibrated to the office, and the patient is provided education and training on how to use the device at home to measure their blood pressure. You can use this code only once per device. This work would typically be done by clinical staff.

Code 99474 is used when the patient brings their blood pressure measurements into the office for review by a physician or nonphysician practitioner. These are the requirements:

  • Self-measurement consists of two readings, taken 1 minute apart;

  • They must be done twice daily over a 30-day period;

  • There must be at least 12 readings over the 30-day period to report this code;

  • The documentation must include average systolic and diastolic pressures; and

  • Documentation must show the subsequent communication of a treatment plan to the patient.

The code description requires a minimum of 12 readings in the 30-day period. Each measurement consists of two readings, 1 minute apart, done twice in 1 day. (Two readings twice in a day = four readings.) This would need to be done at least 3 days in the 30-day period. (Four readings each day for 3 days = 12 readings.)

For this code, the analysis and development of the treatment plan are performed by the physician or NP, but the communication of the plan can be the work of the clinical staff or could be sent via secure messaging to the patient.

Redefining Remote Monitoring

In 2019, CPT developed codes for treatment and management based on data from remote monitoring of healthcare data via a US Food and Drug Administration (FDA)-approved device.

For 2020, CPT is amending the definition of the remote monitoring code 99457, changing it from "20 minutes of time" to the "first 20 minutes." They developed an add-on code, 99458, for each additional 20 minutes of time.

This is good news because it more easily accounts for remote monitoring that takes more than 20 minutes.

There is a similar change for 99457 (Remote physiologic monitoring treatment management services). Here the patient has an FDA-approved device (an Apple watch, for example) or another type of sensor that takes a measurement, like an ECG. The data are electronically transmitted to the physician.

This code pays the physician, NP, or PA to look at the data and then update the treatment plan. An endocrinologist could also use it for blood glucose data submitted electronically.

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