In 2023, the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) have simplified and streamlined medical billing for providers, with more emphasis placed on time and medical decision making and less on documentation requirement. CAPC has updated tools and technical assistance to help you navigate these changes.
5 Tips for Navigating the 2023 Billing and Coding Changes
Here are a few key tips from Dr. Chris Jones, Associate Professor and Director of Outpatient Palliative Care at Duke Health. CAPC members can also watch his short video and register for our upcoming webinar:
• Billing can still be done based on time or complexity. If billing on time, sum all time in the service period (inpatient/office/GIP hospice = 1 day; SNF = 1 day before, day of visit, and 3 days after; home = 3 days before, day of visit, 7 days after). The time thresholds all changed, so make sure to learn the new times.
• If you are billing on complexity, medical decision-making rules the roost. Use the new AMA Evaluation and Management Table. It mirrors what’s been in use in the clinic for 2 years.
• Prolonged services billing is changing. There are 3 new codes (G0316, G0317, G0318) that can be added to the highest time in the code family for inpatient, SNF, and home codes respectively. You’ll need to learn the new time thresholds for prolonged billing.
• Remember the Alamo – and Advance Care Planning (ACP) codes. ACP codes continue and can be billed at 16 minutes (99497) with an additional code available at 46 minutes (99497). ACP codes are likely more useful than the prolonged codes in palliative care, since it is ACP that takes us a long time.
• 99358, the non-face-to-face prolonged services code, is no longer billable from January 1, 2023. Time for non-face-to-face work can be added to the overall time spent in the service period, but losing this code will negatively impact programs that use it frequently.
South Dakota Association of Healthcare Organizations is a proud member of the Center to Advance Palliative Care (CAPC), the nation’s leading resource dedicated to increasing the availability of quality health care for people living with a serious illness. CAPC is offering a 15% discounted membership rate to South Dakota Association of Healthcare Organization members. CAPC members receive exclusive access to technical assistance and clinical training through a robust online course curriculum with free continuing education credits; call-in consulting with national experts in the palliative care field; hundreds of ready-to-use tools and resources; webinars on common topics; and a vibrant, collaborative community of health care professionals working with people living with a serious illness. One CAPC Membership provides an organization’s entire staff with full access to CAPC training, tools, and expert resources. Learn more at capc.org or contact the CAPC Membership Team at membership@capc.org or 646-599-3730.
