Guest Column | February 11, 2019

4 Coding Changes Likely To Impact Healthcare Practices In 2019

By Kayla Matthews, Productivity Bytes

Medical Records

Medical coding brings consistency to the documentation of treatments, procedures and other care patients receive. Medical coding specialists and other people who handle technical aspects of healthcare and facility management have to stay abreast of upcoming or proposed changes. Here are some of them for providers to keep in mind this year.

1. A Trio Of New Codes For Remote Patient Monitoring

Remote patient monitoring (RPM) is a service under the telehealth umbrella that allows providers to keep tabs on people's care between office visits. Recently, the Centers for Medicare & Medicaid Services (CMS) released three new Current Procedural Terminology (CPT) codes affecting coding this year.

These changes broaden reimbursement more than the former CMS telehealth standards, which primarily accommodated patients in rural areas. These new codes do not have geographic boundaries, and they apply to any patient who has had an in-office visit during the previous year.

All three codes went into effect on January 1, 2019, and they are as follows:

  • 99453: Reimburses doctors for setting up remote monitoring equipment and giving patients instructions for using it.
  • 99454: Reimbursements related to the reports or transmissions that remote patient monitoring devices send each day, billed per 30-day span.
  • 99457: Reimburses healthcare workers for the time they spend monitoring the data monthly and applies to monitoring sessions lasting at least 20 minutes.

Since they're already in effect, there's no doubt about whether these RPM codes will affect healthcare practices. The main question is how much, and that depends on how substantially physicians continue to embrace telehealth options. One interesting thing about these codes is that they don't require patient-physician communications via video.

2. Distinct Codes Added For MRI-Based Breast Exams Without Contrast

Several of the CPT code changes for 2019 relate to radiology treatments. One of the major differences in effect this year gives separate billing codes for non-contrast magnetic resonance imaging (MRI) breast exams. Medical coders previously had to use with/without contrast codes. The 2019 change deletes codes 77058 and 77059 and results in an expansion associated with four codes:

  • 77046: Unilateral MRI breast exams without contrast
  • 77047: Bilateral MRI breast exams without contrast
  • 77048: Unilateral MRI breast exams, with/without contrast
  • 77049: Bilateral MRI breast exams, with/without contrast

Moreover, codes 77046 and 77047 encompass computer-aided detection (CAD), including CAD real-time lesion detection, characterization and pharmacokinetic analysis. As such, medical coders no longer have to separately add the Healthcare Common Procedure Coding System (HCPCS) code 0159T for situations involving CAD.

3. Two New Codes For Physician-To-Physician Remote Communications

The internet makes it significantly easier than it once was for physicians to get advice from doctors located in other places. Previously, such consultations were cost-intensive and didn't always allow for real-time feedback.

Connected devices with transmission abilities now enable professionals to get real-time images and audio content about patients. The year 2019 reflects this advancement with two new codes related to consultations occurring across the miles.

Here are the details of those CPT codes:

  • 99451: This code applies to consultive medical sessions lasting at least five minutes. It can involve a collaborating professional communicating via telephone or online and may include electronic health record (EHR) assessment and management services. It also encompasses the assistance given when a consulting physician gives a written report to the treating physician.
  • 99452: This code is similar to the one above, but it applies to the doctor or other healthcare professional requesting the consultant's services. Moreover, it represents sessions lasting no less than a half hour.

These coding changes reflect the changing demands of the healthcare system. They also align with the reality that technology makes it more straightforward for doctors and other health professionals to get advice from each other despite distances.

4. A New Code For Chronic Care Management

CPT code updates for 2019 also relate to chronic care management (CCM). One of them allows providers to bill for at least a half hour of their time. The details of this new code are as follows:

  • 99491: Chronic care management services provided personally by a physician or other qualified healthcare professional for at least 30 minutes.

Health professionals should keep in mind that they cannot bill for services using this code and 99490 or 99487 in the same month. To clarify, 99490 is for Medicare patients with multiple chronic illnesses who get non-face-to-face treatment for 20 minutes or less.

Then, 99487 relates to exceptionally complex patients needing CCM and receiving it through non-face-to-face interactions with providers. Plus, it relates to services that take up at least an hour.

The main thing that's important about 99491 is that it provides a solution for CCM coordination sessions that are more than 20 minutes but less than an hour.

Codes Receive Annual Updates

This list provides several of the code changes for healthcare providers to be aware of during 2019. However, it is by no means reflective of the complete changes to medical coding.

Furthermore, people should check for code changes annually to stay updated.

About The Author

Kayla Matthews is a MedTech writer whose work has appeared on HIT Consultant, Medical Economics and HITECH Answers, among other industry publications. To read more from Kayla, please connect with her on LinkedIn, or visit her personal tech blog at