Coding Tip Corner - January 2024

News Alert!

Effective January 1, 2024, all time thresholds are eliminated from CPT® coding definitions for office and other outpatient settings to better align with all other EM code sets since 2023.

CPT® 2024 has decided to remove the time ranges from both the new and established office/outpatient E/M codes and replace them with a single total time amount, which is the lowest number of minutes in the current range for each code. This time “must be met or exceeded” according to the new wording that now appears in each of the codes’ descriptors.

Beginning January 1, 2024, CMS is finalizing implementation of a separate add-on payment for healthcare common procedure coding system (HCPCS) code G2211. This add-on code will better recognize the resource costs associated with evaluation and management visits for primary care and longitudinal care.

Social Determinants of Health (SDOH)
                
During a required audit on a different subject, we conducted a random review of patient records and looked for the collection of SDOH. This was a small representation of medical records, but not a single one would have passed a review by CMS for the capture of SDOH. Most questions were never even asked, some were asked once in 4 or 5 years. 

Screening for SDOH is important because social factors often have a greater influence on patients’ health than medical care. For those with chronic conditions, socioeconomic factors are even more crucial because they hinder lifestyle changes that are often first-line treatments for those conditions. 

A prime example of this is a patient with type 2 diabetes may be unable to control their A1C if they cannot afford their medications or do not have access to healthy groceries. It is imperative to ask SDOH questions to ensure the patient can be directed to the assistance they need at the time it is needed! HTA stands ready with a multitude of resources that can have a positive impact on members’ lives.

Oftentimes patients do not see a connection between SDOH and their health. This is why offices need to take initiative in assessing social needs on a regular basis. Screening should be a routine part of registration, rooming, obtaining a social history, and seeing the patient. Any clinician can document a patient's social needs. This means that in many cases, coding professionals can utilize documentation of social needs from clinicians including (but not limited to) nonphysician providers such as social workers, community health workers, case managers, nurses, or other providers.

HTA is not asking to increase the staff’s burden when a member has an issue with a “life crisis” such as lack of food or housing concerns. We have given offices a list of resources available to members, or members can contact Member Services through the number on the back of their HTA card. The first step, however, is to identify the need, and that part does lie within the office visit!