On today’s episode, Jason shares an article about how Mark Cuban is expanding his low-cost pharmacy project. And Aron shares about how charging for digital messages may be on shaky ground.

Jason sits down with our guest Steve Adams. A Certified Professional Coder Instructor with InGauge Healthcare Solutions with more than 20 years-experience with training others how to code in all arenas of care. Steve dissects the coding changes for 2023 in the Final Rule, including E&M, new G-codes, and screening reimbursements.

Aaron’s news: https://www.beckerspayer.com/policy-updates/mychart-message-fees-live-on-unstable-ground.html

Jason’s news: https://www.beckershospitalreview.com/pharmacy/mark-cuban-cost-plus-partners-with-2nd-pbm-hints-at-insulin-market-entry.html

Credits

Production Assistance & Editing: Nyla Wiebe

Scripting by: Aaron C Higgins

Show Notes & Transcription: Aaron C Higgins

Social Media Management: Jeremy Miller & Nyla Wiebe

News Co-Hosts: Aaron C Higgins & Jason Crosby

Interview hosts: Jason Crosby

Executive Producers: Mike Scribner & John Crew

Transcript

Jason Crosby
All right, today our guest is Steve Adams, senior consultant with inHealth professional services.
OK, he is a certified professional coder with over 20 years experience of various settings including many, many guest speaking engagement. Steve, thanks for joining us today and welcome to the podcast.
Steve Adams
This it’s my pleasure. This is my first one, so I’m excited.
Jason Crosby
Alright, well, good deal. We’ll tell you what, what the timing of the the podcast we got about a month left just for the listeners month left in the 2022. So obviously the last couple of months.
Lots of changes, final ruling AMA and their coding changes. Let’s let’s dive right in. Can you give us a quick overview of the E&M changes you’re expecting or what you’re seeing for 2023 for the audience?
Steve Adams
Yeah, it’s really it’s really pretty easy. The biggest change that you’re gonna notice in your CPT books this year is there were about 393 changes in the CPT book, but nearly half of those were just revisions and deletions in the evaluation and management section. And you know, when I look at this, I’ve seen a new one, looks like they have about one new code, 49 have been revised and 25 were deleted. And we’re also busy that a lot of times people are missing out.
On all these revisions, and then Medicare just published their Federal Register about three weeks ago, when they came out with a lot of new G codes, they changing the time requirements for depression screens and for alcohol use screening. So there’s a lot of things going on regardless of what specialty you’re in. It would be, it’s worth taking a look at some of these changes that we’re going to go over today.
Jason Crosby
Fantastic. Let’s jump right on then. There which which are some of the key ones that you’re seeing as far as on the deletion side in any revisions that you had mentioned?
Steve Adams
Yeah. I think the biggest thing to kind of realize is that in 2021 CMS and AMA changed the way that we documented our evaluation and management services in the outpatient setting and they did that just to kind of see how it was going to work and it worked so well that now they’ve incorporated those changes into facility based coding. So now what you’re going to see is the opportunity to build total daytime on almost every visit still except the emergency room visits. But we are seeing all that time change we’re seeing now that you just have to have a medically appropriate history and a medically approx.
For an exam for all code. So if you’re used to doing auditing, you no longer will have to download a doctor for an initial hospital visit. If they don’t have 10 review of systems or an 8 organ system exam, I think probably the biggest thing that’s gonna be a change for a lot of people is CMS has done away with the observation codes. So we’ve seen the observation codes, deleted the initial ones, the subsequent the annual nursing facility code has been deleted.
They’ve changed all the domiciliary and rest home as well as home visit code, so they’ve deleted all those and again revised just about everything else. So even if you’re in the emergency room, you know they’ve revised those codes. They’ve revised the consultation codes, nursing home, home health. They’ve made some nice changes to the transitional care management codes that if you’re doing that, I’ll make it a little bit easier to explain to your physicians what’s happening. But those are some of the things that I want to kind of look at today is how they’ve incorporated those.
Observation codes. Now that you might be familiar with 992189921999220 and they’ve just incorporated those into the old initial hospital codes like 99221 used to read initial.
You know, initial hospital visit and now it just says initial hospital or observation service, so you no longer have the discharge code for observation and there’s a couple other little things that are important in there, especially if you do hospital coding.
Jason Crosby
Yeah, it it definitely looks like different settings have some variables that have been tossed in the some of the codes might have gone away, descriptions altered, that sort of thing. So what should folks be looking for that are there on the front lines every day in the coding world?
Steve Adams
I think the biggest thing that you can do is if you do in hospital coding, remember that.
The history and exam is all going to be medically necessary when it’s stressed to your providers about that. You also kind of want to be cognizant of the fact that CMS has dropped the conversion factor this year and some of the codes that we used to do really well on like your initial hospital code used to pay about $200.00. Now it’s down to about 170. The only code that’s really increased are some of your subsequent hospital visit codes and that’s because they’ve really stuck it to us on.
The time components. So if you do hospital coding a lot of times, doctors would do 99233 based on what we call unit 4 floor time. So if you spent greater than 50% of your time on the floor and that time was 35 minutes, you were able to build like a 99233. Now in the hospital nursing home everywhere else they’ve transitioned to total daytime. So it’s gonna be really important for you to update your physicians that the New Times are substantially more.
Then they used to be. So for example a 99233 that used to be 35 minutes greater than 50% was unit. Floor time is now up to 50 minutes unit floor time, so that changes the dynamics a lot on your Level 3 visits and one of the reasons that they went up on those codes, 232 used to be 25. Now it’s 35 minutes. So what you used to be able to Bill is A33 is now A32 and they’ve also taken out of the CPT book and this is important. The disclaimers that used to be under those codes. So it used to be AT233, which everybody wanted to bill, used to have to be 35 minutes greater than 50% unit floor time, or the patient had to have a such a significant problem. They weren’t responding at all to treatment, major complications. So I think that we’re going to see some reductions in the number of 9923 threes. And I mean, I think that when I’m teaching physicians this week and next week on all these changes, that’s the thing. I’m really driving home because at the end of the day, you actually have to document less.
Then you did in the past. The only thing that’s really shifted is the amount of time, and it’s no more greater than 50%. It’s total daytime and in your CPT book they have a section on that and they kind of go over with you. The nine things that count as total daytime. So I would definitely take a look at that, just open up the front of that CPT book and you’ll see all of these changes in the front where you’re and requirements are.
Jason Crosby
So some of the feedback I’ve been reading up on these changes, would you agree that the the process itself is more simple and flexible? What do you think there’s gonna be some natural give and take us folks learn what these changes are?
Steve Adams
I think the changes are the documentation. Requirements are so much easier. I I think that the thing about it is and honestly I’m.
I I work with several hospitalist groups and I think the one thing that’s gonna kill a lot of doctors is this time this additional time required for the 99233. I mean, if you think about a typical hospitalist working a 12 hour shift and they used to be able to build 9923 threes, you know three or four every couple hours and now they’re not able to do that. So I think once you start delving into it is really funny. Before we started talking, you know, I even brought up the fact that I’ve went back to school to get a third degree.
So that just because this stuff is getting a little bit more easy, I have a Plan B myself to back out of this system because this when I started in 92, this stuff was so difficult and it was so just redundant and there was no medicine being practiced. Now that they’re shifting to billing based on the complexity of the patient, that makes everything so much easier for your providers. And the thing that is really impressive is that the AMA has worked with CMS on this. And I mean, I’m really impressed with that. And I think it’s just.
And I think the future is gonna be a lot easier for doctors to support various levels of service.
Jason Crosby
Good feedback for sure. So with all that said, because every year there’s a lot to absorb with such changes.
For audience that’s listening that that is in there every day. What can they do to prepare for those changes here in the next few weeks?
Steve Adams
I think one of the things again that you do is you know you reach out to whoever you’re coding person is whether or not it’s a. If you work with the State Medical society. I know I do consulting for the Georgia Academy of Family Practice, Georgia, OBGYN Society, the American College of Physicians, and those are areas where if you’re part of those groups, you can they have webinars every year. I’m doing the OBGYN when this Friday and the Georgia Academy of Family Practice next week.
If you’re in plastic surgery, you can contact the Georgia Academy of Plastic Surgery, ophthalmology into whatever they should have some resources for you. Normally they have a consultant who works closely with them. Who does these kinds of E&M seminars that will get you ready and that way it’ll save you some money because the biggest thing that I see and I hate.
These companies who send you these emails that say, you know, did you know there were 373 coding changes and for $750, you know, we can explain it to you. And I always tell my private clients, you know, don’t do that unless it’s somewhere like in Las Vegas where you can fly out there or Miami this time of the year. But don’t get confused by the emails that you’re going to get. Contact your specialty societies, your national society. And again, they’re going to have some resources that will give you this information because.
I mean, if you look at Medicare, especially with prolong services, when we know that we had the 99417, when we went 15 minutes over for an outpatient facility code and then Medicare came up with their own code G2O12 and now we have these new prolong service codes for hospital. You know AMA came out with 99418, but now we also have Geo 3160317, go 318. There’s just so many little nuances.
In the coding world that you really, if you don’t want to pay a lot of money, reach out to your societies first. And I think that’s gonna be your best bet.
Jason Crosby
Yeah. So if if you’re a kind of keep going down that path.
If if you’re sort of new into the field or looking to to sort of take on this new skill set and maybe this is kind of OK Steve, go back to when you first got into the field.
How describe how best for that person to maybe expand on that if they’re just starting out aside from reaching out to the consultants, any other types of resources, education tracks or maybe highlight for us how you got into it as well?
Steve Adams
The hard thing about any kind of coding change is that they’re honestly just, there’s not a lot of people out there who specialize it anymore. I’d be just honest with you. It’s really hard. A lot of the hospital systems that I used to consult with have just decided, well, hey, listen, we’re going to go out and hire a guy full time to work in our facility. So what I would tell people to do because my neighbor, I helped her become certified and she’s worked for a great family practice here in Augusta.
For, you know, at least a decade and what I would tell her is just go to Google.
Umm, I mean, I have a wife and kids and dogs and cats and I love to make money, but I I’ve been in this business since 1992 because I wanna save people money and I would literally just go to Google and or YouTube and I would just type in 2023.
E&M coding changes or 2023 CPT. Coding changes and there are people who put out free information to kind of draw traffic to their website. So I would if your society doesn’t have anything and you want to learn more about coding, that’s a good place to start. Another fantastic place to start is your local aapc coding chapter. Now, if you’ve got an ink pen, I’ll tell you how to do this. I get calls at least once a week. Somebody who wants to enter this field.
Steve Adams
And when I tell him to do is coders on the on the whole are pretty introverted. We only like our own people and we get together usually every month that these local coding chapters and these local coding chapters, you get an opportunity to network with fellow nerds. And even if you’re not certified, you can do that. And the way that you do that is simple. You just, I’m going to give you a phone number. You’re going to call them or you can go on their website, you find a local coding chapter. You can join that local coding chapter and then they have guest speakers who come once a month, either virtually or in person.
And they talk about this and it’s so stupid to say this, but I mean, I’m a pretty big deal in this business and I have a a local chapter right here in Augusta, and they never ask me to speak anymore. I don’t know if it’s because they’re afraid I’m going to take their clients. I don’t know what it is, but I try to tune in every once in a while to a local chapter meeting and you’ll find good resources there. So here’s what you do. You call one 800-626-2633 and it’s easy to remember. That’s one 800-626-CODE.
Since a lot of us are on social media and etcetera, you can go also to the Internet and just go to Aapc American Academy of Professional coders.com. Apc.com has a lot of great resources and you can just call them and you can go to their website and just look for local coding chapters, call them up and just say, hey, listen, I live in the perimeter area of Atlanta. Do you have a coding chapter? They’ll tell you who the contact person is. You look them up, they’re going to have people come in and talk about.
Uh, talk about this. These coding changes and again, that’s a membership opportunity for you. And so that’s what I would say, yes. And I would say if you want to get into this field, I every time I talk to somebody, I’m like, yeah, you can come to one of my coding classes, but I can’t get you a job. You’re only going to get a job, usually through these local coding chapters. So I hope that wasn’t too long of an explanation, but use YouTube, Google, go to apc.com, join their organization. They send out newsletters, they have webinars that you can attend as well. And that’s how I would recommend it.
Jason Crosby
Fantastic. Fantastic. Very, very helpful. And it I I would add to that, it probably doesn’t matter what type of setting you’re in where you’re located there. There’s always an evolution to this part of the field that’s always going to have some sort of demand to it.
Steve Adams
And Jason, I don’t wanna interrupt you here, but I I’m going to because a lot of times people think well, I don’t want to be a certified professional coder. You know, I’ve been coding for 20 years. I don’t wanna be a CPC, the aapc of which I receive no money from. Trust me. God, I pay them probably $2500 a year just to teach their stuff and give their test. But they have credentialing for specialists. So, I mean, if you’re a GI coder, you don’t want to be a CPC, become a GI coder. You can take their certification test. Interventional radiology.
Again, you can do so many different things right now a big field is HCC and risk value based coding. You can take their online home study courses for that. There’s just so many opportunities. They’re on Facebook, they’re on Twitter. They have a campaign right now that just talks about how people have a three times better chance of passing their national exams. If you take their their online courses. So just don’t be constrained. And just think I want to be a CPC and know a little bit about everything, focus in on your specialty. That’s another opportunity for you to learn.
Jason Crosby
Great insight as we wrap up here to tell our listeners how can they get in touch with you if they need to request your services.
Steve Adams
It is so simple to reach out to me, the first thing I tell people is just my e-mail. So I have a I work for a firm called in health and that’s in Atlanta. I live in Augusta. A lot of people just send me emails because I’ve known in this industry as the King of coders. So really easy way that people reach out to me is just going to the king of coders@gmail.com and sending me an e-mail. I tried to make things simple. So the king of coders@gmail.com you can also go to my website. I’ve just updated it. A lot of that information that we’re talking about today I have.
The ICD 10 manual up there, I just have a lot of resources for 2023 and it’s easy to remember that too because I made coding consultant so my website isthecodingconsultant.com and you can go out there and take a look at some of my stuff and you can e-mail me from there. You can call me. There’s no secretary since 1992. It’s just been me, a rental car and a laptop and my number is simple, it’s 706-483-4728 and just in case my firm hears me, my company e-mail is steve.adams@inhealthps.com and that’s why I never give out that web because it’s a I don’t understand. When I worked at Mag Mutual, my e-mail was so cool. They used the first initial of your name and your last name at Mag Mutual. So I was saddams@magmutual.com. Now, if you’re, you know, I was involved in the first Gulf War, so it was really cool for me because older people remembered Saddam Hussein. So don’t send emails to saddams@magnitude.com I no longer work there. They sold us. So the kingofcoders@gmail.com is probably the best way to reach out to me or go to my website.
Jason Crosby
That’s awesome, Steve. That’s good. Alright, well, well, great information, Steve. We can certainly go on for hours, probably just diving into the details each time they’re it changes and we’ll have to certainly have you on again soon and really appreciate your time and joining us today.
Steve Adams
To my pleasure, half an hour out of my life is no problem. This is my first podcast. I can’t wait to tell everybody that I was officially on a podcast now, and I’ll be making millions of dollars and endorsement deals, and I’ll be pimping AMA stuff and ICD 10 products. I’ll have my own shirt line. It’ll be great. So thanks for giving me the opportunity to retire early. Guys. I really appreciate it.