Beyond the Stethoscope: Vital Conversations with SHP
Revisit: Coding Changes for 2023 (Including E&M, New G-Codes, and Screening Reimbursements) | With Steve Adams
Jul 31, 2024Season 4Episode 18
Strategic Healthcare Partners
BtS is taking a summer vacation, but we want to take a walk down memory lane. Revisit this classic episode with us.
On today’s episode, Jason shares an article about how Mark Cuban is expanding his low-cost pharmacy project. And Aron shares about how charging for digital messages may be on shaky ground.
Jason sits down with our guest Steve Adams. A Certified Professional Coder Instructor with InGauge Healthcare Solutions with more than 20 years-experience with training others how to code in all arenas of care. Steve dissects the coding changes for 2023 in the Final Rule, including E&M, new G-codes, and screening reimbursements.
BtS is taking a summer vacation, but we want to take a walk down memory lane. Revisit this classic episode with us.
On today’s episode, Jason shares an article about how Mark Cuban is expanding his low-cost pharmacy project. And Aron shares about how charging for digital messages may be on shaky ground.
Jason sits down with our guest Steve Adams. A Certified Professional Coder Instructor with InGauge Healthcare Solutions with more than 20 years-experience with training others how to code in all arenas of care. Steve dissects the coding changes for 2023 in the Final Rule, including E&M, new G-codes, and screening reimbursements.
Welcome to Beyond the Stethoscope, Vital Conversations with SHP. As we take a well-deserved summer break to prepare for the exciting Season 5, we want to keep bringing you valuable content, so we're revisiting some of our most insightful conversations from past seasons To date. We're re-airing our interview with Steve Adams all the way back from Season 1. Steve's insights were ahead of their time and continue to resonate as we navigate through 2024. In our discussion, Steve shared some thought-provoking perspectives and actionable advice, just as relevant today as it was when we first aired this episode. If you'd like to connect with Steve, you can find him on LinkedIn and thecodingeducatorcom. As always, please rate and share this podcast in your favorite podcast app. It really helps us grow and reach more listeners. So thank you for joining us on this re-listening journey. So let's dive back into Conversations with SHP.
Aaron Higgins:
On today's episode, Jason shares an article about how Mark Cuban is expanding his low-cost pharmacy project. Then I share how charging for digital messages may be on shaky ground. The Jason sits down with Steve Adams, certified professional coder, instructor with Engage Healthcare Solutions, with more than 20 years experience with training others how to code in all arenas of care. Steve dissects the coding changes for the 2023 final rule, including changes to E&M, the new G codes and, of course, screening reimbursements. Are you ready for this vital conversation? Let's get going.
Jason Crosby:
Hey Aaron, how are you doing today bud?
Aaron Higgins:
Hey, I'm doing pretty good, jason, yourself.
Jason Crosby:
Doing fantastic Time of the week again. We got a lot of news out today. What caught your attention out in the news article?
Aaron Higgins:
world. Well, if you remember, a few weeks ago there was a lot of buzz around the Cleveland Clinic when they announced that they were going to start charging for certain epic MyChart messages that they received. The rationale and the argument is that their clinicians are spending a lot of time diagnosing and responding to patient healthcare needs at the expense of their patients that they're seeing in billable time, and so that caused quite a stir. A lot of people are like well, it's like charging for an email and I feel like the Cleveland Clinic's rationale makes sense on the surface. It certainly, I think, needs a lot more testing and understanding how that's going to happen.
Aaron Higgins:
But this Becker's article has a really great article. We'll link to it in the show notes. Ecker's article has a really great article. We'll link to it in the show notes. Its headline kind of sums up the article that the Mitra message fees live on unstable ground, and in this article they talk about some of the other organizations, like Cleveland Clinic that have jumped onto this bandwagon of oh hey, we should bill for physician time. Bill for physician time.
Aaron Higgins:
But they get some comments from private payers United Healthcare, aetna, cigna, just to name a few and kind of their hot takes on what this looks like, and we're looking about a $3 to $10 charge that this is probably going to generate. Cms has issued a little bit of guidance on it, but in all, this was kind of a surprise to the industry, so it's going to be really interesting to see how this shapes up On the surface. I understand it Our clinicians' resources are stretched really thin now, and so we're potentially asking them to set aside several hours in a day to respond to messages In lieu of a patient coming in. Is that something that should be billed for? I think the answer might be yes, but there's some long-term ramifications to think about here. But again, we'll link to this in the show notes. I think it's definitely worth a look at, particularly if you're really reliant on your patient portal for communication with your clinicians.
Jason Crosby:
You're really reliant on your patient portal for communication with your clinicians.
Jason Crosby:
Well, I found another interesting disruptive type of article from one that's been doing a lot of disruption of late.
Jason Crosby:
Mark Cuban, with the Mark Cuban Cost Plus Drug Company, forged yet another partnership, this one with Emsana RX, to form Emsana RX Plus here just this week.
Jason Crosby:
The intention of it is to target employer-sponsored drug benefit plans, and so obviously we've talked about a lot of direct to employer type contracting models out there and this partnership to help identify and find discounts and lower cost drug medications for those types of employers. Cuban's online drug company already has roughly 1,000 generic drugs at a pretty steep discount, and so they've got some volume there, starting to make a little bit of headway, and so there's lots of excitement what that's going to generate this on top of a partnership earlier this fall with RightWay, again targeting other employers on the discount side of things, and then most recently, if you keep up with the Twitter world, he's posted out there trying to tap into the insulin space with testing our program, looking at surveys to see about you know how folks may be receptive to a I think it's a 90-day supply for $170 with shipping, and so we all know a lot can be done in that space, and so Mark Cuban doing a lot of disruption of late. I'm excited to see where he goes.
Aaron Higgins:
Yeah, I'm excited to see innovators in that space, because there's really not a whole lot of innovation other than with pricing that can truly happen Already. Well, I think that wraps up our headlines today. We got a guest there, Jason.
Jason Crosby:
We do. We have Steve Adams. Steve is a billing and coding expert. Great presentation. He's going to go over a lot of the changes taking place, especially in the E&M valuation and management space of coding for 2023. Very helpful. Worth a listen. Great conversation with Steve.
Aaron Higgins:
All right, looking forward to listening to it. All righty, I think that's it for today. Fantastic Thanks everybody.
Jason Crosby:
Today, our guest is Steve Adams, Senior Consultant with End Health Professional Services. He is a certified professional coder with over 20 years experience in various settings, including many, many guest speaking engagements. Steve, thanks for joining us today. Welcome to the podcast.
Steve Adams:
My pleasure. This is my first one. I'm excited, all right, well, good to one.
Jason Crosby:
I'm excited, All right. Well, good deal. I'll tell you what the timing of the podcast. We've got about a month left, just for the listeners, a month left in the 2022. So obviously, the last couple of months, lots of changes on a rolling AMA and their coding changes. Let's dive right in. Can you give us a quick overview of the E&M changes you're expecting or what you're seeing for 2023 for the audience?
Steve Adams:
Yeah, it's really pretty easy. The biggest change that you're going to notice in your CPT books this year is there were about 393 changes in the CPT book, but nearly half of those were just revisions and deletions in the evaluation and management section. Those were just revisions and deletions in the evaluation and management section and you know, if I look at this, you know I've seen a new one. It looks like they have about one new code. Forty-nine have been revised and 25 were deleted, and we're also busy that a lot of times people are missing out on all these revisions. And then Medicare just published their federal register about three weeks ago and they came out with a lot of new G codes. They're changing the time requirements for depression screens and for alcohol use screening. So there's a lot of things going on. Regardless of what specialty you're in, it's worth taking a look at some of these changes that we're going to go over today.
Jason Crosby:
Fantastic. Let's jump right on in there, which are some of the key ones that you're seeing as far as on the deletion side and any revisions that you had mentioned.
Steve Adams:
Yeah, I think the biggest thing to kind of realize is that in 2021, cms and AMA changed the way that we documented our evaluation and management services in the outpatient setting, and they did that just to kind of see how it was going to work. And it worked so well that now they've incorporated those changes into facility-based coding. So now what you're going to see is the opportunity to build total daytime on almost every visit still except the emergency room visits but we are seeing all that time change. We're seeing now that you just have to have a medically appropriate history and a medically appropriate exam for all codes. So if you're used to doing auditing, you no longer will have to downcode a doctor for an initial hospital visit if they don't have 10 review of systems or an eight organ system exam.
Steve Adams:
I think probably the biggest thing that's going to be a change for a lot of people is CMS has done away with the observation codes.
Steve Adams:
So we've seen the observation codes deleted the initial ones, the subsequent, the annual nursing facility code has been deleted. They've changed all the domiciliary and rest home as well as home visit codes. They've deleted all those and again revised just about everything else. So even if you're in the emergency room. You know they've revised those codes, they've revised the consultation codes, nursing home, home health. They've made some nice changes to the transitional care management codes that, if you're doing that, it'll make it a little bit easier to explain to your physicians what's happening. But those are some of the things that I want to kind of look at today is how they've incorporated those observation codes now that you might be familiar with 99218, 99219, 99220. And they've just incorporated those into the old initial hospital codes, like 99221 used to read initial, you know, initial hospital visit, and now it just says initial hospital or observation service. So you no longer have the discharge code for observation and there's a couple other little things that are important in there, especially if you do hospital coding.
Jason Crosby:
Yeah, it definitely looks like different settings have some variables that have been tossed in. Some of the codes might have gone away. Descriptions altered that sort of thing, so what should folks be looking for that are there on the front lines every day in the coding world.
Steve Adams:
I think the biggest thing that you can do is, if you're doing hospital coding, remember that the history and exam is all going to be medically necessary. I want to stress to your providers about that. You also kind of want to be cognizant of the fact that CMS has dropped the conversion factor this year and some of the codes that we used to do really well on, like your initial hospital code, used to pay about $200. Now it's down to about $170. The only code that's really increased are some of your subsequent hospital visit codes and that's because they've really stuck it to us.
Steve Adams:
On the time components, so if you do hospital coding a lot of times, doctors would do 99233, based on what we call unit four floor time. So if you spent greater than 50% of your time on the floor and that time was 35 minutes, you were able to bill like a 99233. Now in the hospital, nursing home, everywhere else, they've transitioned to total daytime. So it's going to be really important for you to update your physicians that the new times are substantially more than they used to be. So, for example, a 99233 that used to be 35 minutes greater than 50% was unit floor time is now up to 50 minutes unit floor time. So that changes the dynamics a lot on your level three visits and one of the reasons that they went up on those codes 232 used to be 25, now it's 35 minutes. So what you used to be able to bill as a 3-3 is now a 3-2.
Steve Adams:
And they've also taken out of the CPT book and this is important the disclaimers that used to be under those codes.
Steve Adams:
So it used to be a 2-3-3, which everybody wanted to bill used to have to be 35 minutes greater than 50% unit floor time or the patient had to have such a significant problem they weren't responding at all to treatment, a major complication. So I think that we're going to see some reductions in the number of 99233s. And I mean I think that when I'm teaching physicians this week and next week on all these changes, that's the thing I'm really driving home, because at the end of the day you actually have to document less than you did in the past. The only thing that's really shifted is the amount of time, and it's no more greater than 50%, it's total daytime and in your CPT book they have a section on that and they kind of go over with you the nine things that count as total daytime. So I would definitely take a look at that. Just open up the front of that CPT book and you'll see all of these changes in the front where your E&M requirements are.
Jason Crosby:
So some of the feedback I've been reading up on these changes. Would you agree that the process itself is more simple and flexible, or do you think there's just going to be some natural give and take as folks learn what these changes are?
Steve Adams:
I think the changes are the documentation requirements are so much easier. I think that the thing about it is and honestly, I work with several hospitalist groups and I think the one thing that's going to kill a lot of doctors is this time, this additional time required for the 99233. I mean, if you think about a typical hospitalist working a 12-hour shift and they used to be able to build 99233s, you know three or four every couple hours and now they're not able to do that. So I think once you start delving into it, it's really funny.
Steve Adams:
Before we started talking, you know, I even brought up the fact that I went back to school to get a third degree, so that just because this stuff is getting a little bit more easy, I have a plan B myself to back out of this system because this, when I started in 92, this stuff was so difficult and it was so just redundant and there was no medicine being practiced. Now that they're shifting to billing based on the complexity of the patient, that makes everything so much easier for your providers. And the thing that is really impressive is that the AMA has worked with CMS on this and I mean I'm really impressed with that and I think it's just. I think the future is going to be a lot easier for doctors to support various levels of service.
Jason Crosby:
Good, feedback for sure. So, with all that said, because every year there's a lot to absorb with such changes for our audience that's listening, that is in there every day, what can they do to prepare for those changes here in the next few weeks?
Steve Adams:
I think one of the things again that you do is you know you reach out to whoever your coding person is, whether or not it's a. If you work with a state medical society I know I do consulting for you know the Georgia Academy of Family Practice, Georgia OBGYN Society, the American College of Physicians, and those are areas where, if you're part of those groups, you can. You know they have webinars every year. I'm doing the OBGYN one this Friday and the Georgia Academy of Family Practice next week. If you're in plastic surgery, you can contact the Georgia Academy of Plastic Surgery, Ophthalmology, ent, whatever. They should have some resources for you. Normally they have a consultant who works closely with them, who does these kinds of E&M seminars. That will get you ready and that way it'll save you some money.
Steve Adams:
Because the biggest thing that I see and I hate these companies who send you these emails that say you know, did you know there were 373 coding changes and for $750,.
Steve Adams:
You know, we can explain it to you and I always tell my private clients, you know, don't do that unless it's somewhere like in Las Vegas where you can fly out there or Miami this time of the year. But don't get confused by the emails that you're going to get Contact your specialty societies, your national society, and again they're going to get Contact your specialty societies, your national society, and again they're going to have some resources that will give you this information. Because I mean, if you look at Medicare, especially with prolonged services, when we know that we had the 99417, when we went 15 minutes over for an outpatient facility code, and then Medicare came up with their own code, g2012. And now we have these new prolonged service codes for hospital. You know, ama came out with 99418, but now we also have G0316, g0317, g0318. There's just so many little nuances in the coding world that you really, if you don't want to pay a lot of money, reach out to your societies first and I think that's going to be your best bet.
Jason Crosby:
Yeah. So if you're a kind of keep going along that path, if you're sort of new into the field or looking to sort of take all this new skill set, maybe this is kind of okay. Steve, go back to when you first got into the field. Describe how best for that person to maybe expand on that if they're just starting out Aside from reaching out to the consultants any other types of resources, education tracks, or maybe highlight for us how you got into it.
Steve Adams:
The hard thing about any kind of coding change is that there honestly just there's not a lot of people out there who specialize in it anymore. I'll be just honest with you, it's really hard. A lot of the hospital systems that I used to consult with have just decided well, hey, listen, we're going to go out and hire a guy full-time to work in our facility. So what I would tell people to do because my neighbor I helped her become certified and she's worked for a great family practice here in Augusta for you know at least a decade and what I would tell her is just go to Google. I mean, I have a wife and kids and dogs and cats and I love to make money, but I've been in this business since 1992 because I want to save people money and I would literally just go to Google or YouTube and I would just type in 2023 E&M coding changes or 2023 CPT coding changes, and there are people who put out free information to kind of draw traffic to their website. So I would you know, if your society doesn't have anything and you want to learn more about coding, that's a good place to start. Another fantastic place to start is your local AAPC coding chapter. Now, if you've got an ePIN, I'll tell you how to do this. I get calls at least once a week. Somebody wants to enter this field and what I tell them to do is coders on the whole are pretty introverted. We only like our own people, and we get together usually every month at these local coding chapters. And these local coding chapters you get an opportunity to network with fellow nerds and even if you're not certified, you can do that. And the way that you do that is simple. You just I'm going to give you a phone number, you're going to call them or you can go on their website. You find a local coding chapter. You can join that local coding chapter and then they have guest speakers who come once a month, either virtual or in person, and they talk about this. And it's so stupid to say this, but I mean, I'm a pretty big deal in this business and I have a local chapter right here in Augusta and they never ask me to speak anymore. I don't know if it's because they're afraid I'm going to take their clients. I don't know what it is, but I try to tune in every once in a while to a local chapter meeting and you'll find good resources there. So here's what you do you call 1-800-626-2633. And it's easy to remember that's 1-800-626-CODE C-O-D-E, since a lot of us are on social media et cetera. You can go also to the internet and just go to AAPC American Academy of Professional Coderscom.
Steve Adams:
Aapccom has a lot of great resources and you can just call them and you can go to their website and just look for local coding chapters. Call them website and just look for local coding chapters. Call them up and just say, hey, listen, I live in the perimeter area of Atlanta. Do you have a coding chapter? They'll tell you who the contact person is. You look them up. They're going to have people come in and talk about these coding changes and again, that's a membership opportunity for you. And so that's what I would say. And I would say, if you want to get into this field, every time I talk to somebody I'm like, yeah, you can come to one of my coding classes, but I can't get you a job. You're only going to get a job usually through these local coding chapters. So I hope that wasn't too long of an explanation. But you know, use YouTube, google, go to AAPCcom, join their organization. They send out newsletters, they have webinars that you can attend as well.
Jason Crosby:
And that's how I would recommend it Fantastic, fantastic, very, very helpful. I would add to that it probably doesn't matter what type of setting you're in, where you're located. There's always an evolution to this part of the field. It's always going to have some sort of demand to it.
Steve Adams:
People think well, I don't want to be a certified professional coder. You know I've been coding for 20 years. I don't want to be a CPC the AAPC of which I receive no money from. Trust me God, I pay them probably $2,500 a year just to teach their stuff and give their tests. But they have credentialing for specialists. So I mean, if you're a GI coder, you don't want to be a CPC? Become a GI coder. You can take their certification test. Interventional radiology Again. You can do so many different things. Right now, a big field is HCC and risk value-based coding. You can take their online home study courses. For that there's just so many opportunities. They're on Facebook, they're on Twitter. They have a campaign right now that just talks about how people have a three times better chance of passing their national exams if you take their online courses. So just don't be constrained and just think I want to be a CPC and know a little bit about everything. Focus in on your specialty. That's another opportunity for you to learn.
Jason Crosby:
Great insight. Well, as we wrap up here, tell our listeners how can they get in touch with you if they need to request your services.
Steve Adams:
It is so simple to reach out to me. The first thing I tell people is just my email. I work for a firm called InHealth and that's in Atlanta. I live in Augusta. A lot of people just send me emails because I'm known in this industry as the king of coders. So a really easy way that people reach out to me is just going to thekingofcoders at gmailcom and sending me an email. I try to make things simple. So, thekingofcoders at gmailcom. You can also go to my website. I've just updated a lot of that information that we're talking about today. I have the ICD-10 manual up there. I just have a lot of resources for 2023. And it's easy to remember that too, because I'm a coding consultant. So my website is thecodingconsultantcom and you can go out there and take a look at some of my stuff and you can email me from there. You can call me. There's no secretary since 1992. It's just been me a rental car and a laptop, and my number is simple it's 706-483-4728. And, just in case my firm hears me, my company email is steveadams at inhealthpscom, and that's why I never give out that web, because it's I don't understand.
Steve Adams:
When I worked at mag mutual, my email was so cool. They used the first initial of your name and your last name at mag mutual. So I was Saddam's at mag mutualcom. Now, if you're, I was. I was involved in the first Gulf war, so it was really cool for me, because older people remembered Saddam Hussein. So don't send emails to Saddam's at mag mutualcom. I no longer work there. They sold us. So the king of coders at Gmail is probably the best way to reach out to me or go to my website.
Jason Crosby:
All right, Well, great information, Steve. We can certainly go on for hours probably just diving into the details each time there are changes. We'll have to certainly have you on again soon and really appreciate your time and joining us today.
Steve Adams:
It's my pleasure. Half an hour out of my life is no problem. This is my first podcast.
Aaron Higgins:
I can't wait to tell everybody that I was officially on a podcast You've been listening to Beyond the Stethoscope Vital Conversations with SHB. This has been a production of Strategic Healthcare Partners. Your news shows today were Jason Crosby and me, aaron Higgins. It is produced and edited by Nyla Weave. Our social media content producers are Nyla Weave and Jeremy Miller and our executive producers are Mike Scribner and John Kroop. For more information about SHP and the services we offer, including the back library of episodes, episode transcripts, links to resources discussed and much, much more, please visit our website at shplccom. Thanks for listening.
