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A Medical Billing expert discussing the latest changes in E/M coding guidelines and payment policy in 2024

Highly Anticipated 2024 Coding and Payment Policy Changes (E/M Edition)

We have got some significant changes for you to go through for the upcoming year. In this article, we’ll discuss the key important highlights of this release coming in 2024!! Boost your firm's skills and revenue cycle with updated insights for the new year.

Let’s begin the new year with up-to-date information that can help benefit you as a medical billing or coding firm elevate your practice management skills and make your revenue cycle improved.!

2024 CPT update: 349 changes, including 230 new codes, 49 deletions, and 70 revisions. CPT now has 11,163 codes covering medical procedures & services, growing with innovation.

2024 CPT introduces Spanish descriptors for medical procedures and services.

"2024 CPT adds Spanish to help 41M US Hispanics access medical procedures."

Lori Prestesater, AMA senior vice president of health solutions said in the release.

Let’s Begin with Changes in E/M Coding

2024 CPT revises evaluation and management (E/M) sections to reduce provider documentation burden. In addition, a new E/M subsection with new guidelines for split or shared services will be created. New codes align with current E/M office/outpatient services structure.

The following updates will include:

  • 2024 CPT removes time ranges from office visit codes 99202-99205 and 99212-99215.
  • The portion of physician’s services that may be reported for split (or shared) visits will be defined.
  • 2024 CPT adds guidance for codes 99234-99236 spanning two dates.

Revised Codes

The following E/M codes will be revised in the CPT 2024 code set:

  • 99202: New patient office visits with history, exam, and straightforward decisions. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.
  • 99203: New patient office visits with history, exam, and low-level decisions. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter.
  • 99204: New patient office visits with history, exam, and moderate decisions. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter.
  • 99205: New patient office visits with history, exam, and high-level decisions. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter.
  • 99212: Established patient office visits with history, exam, and straightforward decisions. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter.
  • 99213: Established patient office visits with history, exam, and low-level decisions. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.
  • 99214: Established patient visit with history, exam, and moderate decision-making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.
  • 99215: Complex outpatient visit for an established patient with high medical complexity. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.

Nursing Facility Changes and Revisions

  • 99306: Initial nursing facility visit for a patient with high medical complexity. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
  • 99308: Follow-up nursing facility visit for a patient with low medical complexity. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.

Changes in ‘Split/Shared’ Services E/M Visits

Shared E/M between multiple clinicians managing a patient simultaneously. In 2022-23, clinicians could choose between history, exam, MDM, or time for E/M coding. From 2024, split/shared services based on time >50%.

Code descriptor revisions are about time.

A table illustrating the E/M codes and their comparison between the year 2023 and 2024

CMS inquiries led to CPT 2024 updates for E/M service reporting clarity. The revisions include:

  • Time ranges removed from select outpatient visit codes to match other E/M codes.
  • Defining "substantive portion" of split/shared E/M visits by physician-non-physician collaboration.
  • Guidelines for reporting inpatient care (99234-99236) when patient stay spans dates.
  • E/M reporting codes revised for clarity following CMS requests.

Revision in Nursing Facility E/M Visits

Nursing facility visit codes revised with 5-minute addition:

  • 99306: Initial nursing facility care for a patient with complex needs. Total time for code selection: 45 minutes (Now 50 minutes).
  • 99308: Follow-up nursing facility care for a patient with basic needs. Total time for nursing facility care code selection: 15 minutes (Now – 20 minutes) must be met or exceeded.

G2211 implementation in 2024

G2211 G2211 Visit complexity is crucial for managing serious or complex medical conditions. (Add-on code for office/outpatient E/M visit, new or established)

G2211 is purposed to have the most interesting development

This add-on code acknowledges resource costs for primary & longitudinal care E/M visits. Add-on code for outpatient/office visits, recognizing costs for complex care coordination.

  • G2211 is an add-on code for office and other outpatient services (99202-99215).
  • G2211 will benefit primary care and specialists providing ongoing complex care. CMS is proposing not to pay for the add-on code when used with modifier 25, on the date of a minor procedure.
  • G2211 for ongoing care of acute conditions. CMS is emphasizing the relationship between the patient and the practitioner. Acute visits may not be part of continuous care, which defines G2211.
  • No documentation, specialty, or billing amount specified for G2211 yet. However, the experts estimate it to be around $20.
  • CMS will clarify key details when implementing G2211 in 2024, including guidelines & pricing.

New E/M codes align with current structure, add virtual check-in for visit necessity.

Telemedicine Office Visits

From 2024, CMS pays home telehealth at non-facility PFS rate, aligning with CAA 2023 for access.

CPT/RUC Telemedicine Workgroup guides E/M coding for audio-visual & audio-only telemedicine visits. New E/M subsection with telemedicine guidelines added to CPT 2024.

Place of Service Codes for Medicare Telehealth Services. From 2024, POS 10 (Telehealth in Patient's Home) claims paid at non-facility PFS rate. POS 2 (Telehealth not in Patient's Home) claims paid at PFS facility rate for non-home sites.

Deleted Codes

The codes below will be deleted from the CPT 2024 code set:

  • 99441: Telephone E/M by physician for established patient, 5-10 mins, not related to prior/next 24 hrs E/M.
  • 99442: Telephone E/M by physician for established patient, 11-20 mins, not related to prior/next 24 hrs E/M.
  • 99443: Telephone E/M by physician for established patient, 21-30 mins, not related to prior/next 24 hrs E/M.
  • 99459: Female pelvic exam (list separately in addition to code for primary procedure)

Billed with Office Visits or as a Preventive Care service. Could not be billed separately earlier

99459 captures practice expenses for female pelvic exam during Office visit. As an add-on code, it should be reported only for the same date of service with the codes listed above.

Changes in Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule

CMS issued final rule on Nov 2, 2023 with PFS policy changes effective Jan 1, 2024. CY 2024 PFS rule supports healthcare equity for better access, quality, affordability, & innovation.

CY 2024 PFS Rate Setting and Conversion Factor, In summary

By factors specified in law, overall payment rates under the PFS will be reduced by 1.25% in CY 2024 compared to CY 2023. CMS is also finalizing significant increases in payment for primary care and other kinds of direct patient care.

The final CY 2024 PFS conversion factor is $32.74, a decrease of $1.15 (or 3.4%) from the current CY 2023 conversion factor of $33.89.

  • CMS released CY 2024 PFS on Nov. 2, 2023.
  • Physicians face 3.37% cut for CY 2024.
  • Rule for Medicare payments under PFS and Part B issues effective Jan. 1, 2024.
  • Physicians face 3.37%+ cut for CY 2024. Cuts align with rising practice costs; CMS projects 2024 MEI increase at 4.6%.

AltuMED is a Medical Billing Services and Solutions company, with more than 13 years of expertise in the industry. Our coding experts are well-versed and leave no room for error. Partner with us to avoid any coding inaccuracies.

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