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    How to take advantage of new coding opportunities in 2017

    A new year means new codes and new revenue opportunities for medical practices—but also new challenges to ensure the codes are used correctly.

    Below is a brief summary of new current procedural terminology (CPT) codes, modifiers and place of service codes that went into effect January 1, 2017.

    Add-on prolonged E/M services 

    You’ll find a new billing opportunity in 2017 for the work your providers conduct behind the scenes, as the Centers for Medicare & Medicaid Services (CMS) activates two CPT codes—99358 and 99359—that pay for non face-to-face prolonged services.

    Codes for prolonged E/M services before and/or after direct patient care are:

    99358: first hour 

    99359: each additional 30 minutes
    (List separately in addition to code
    for prolonged service).

    Keep in mind that these services cannot be reported during the same month as Transitional Care Management services (99487, 99489, 99495 and 99496) or Complex Chronic Care Management services (99487 and 99489). However, CMS has stated that prolonged services “cannot be reported during the TCM 30-day service period by the same practitioner who is reporting the TCM,” which suggests that another provider could bill.

    Also, CMS will allow the new code G0505 (cognition and functional assessment by the physician or other qualified health care professional in office or other outpatient) to be billed as an “associated companion code, whether furnished on the same day or a different day” to 99358 and 99359. However, they cannot be billed with the new add-on code G0506.

    New codes for health risk assessments

    As of January 1, there are two new codes for performance of health risk assessments:

    96160: Administration of patient-focused health risk assessment instrument (e.g., health hazard appraisal) with scoring and documentation,

    per standardized instrument.

    96161: Administration of caregiver-focused health risk assessment instrument (e.g., depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument.


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