2020 CPT Changes For Pediatrics

One of the benefits of working at PCC is that I am surrounded by nice and smart people (which, oddly, I never hear anyone else mentioning...weird).  As a practical benefit, it means that if I don't know something, I usually just need to ask a question aloud and someone will come to my rescue.  Or, in this instance, I can just send a note to Jan Blanchard, our nationally recognized resident coding expert, and she'll pour me a gallon of CPT response.  I was working on the impact of the 2020 RVU changes for pediatricians and I realized the conversation isn't entirely complete without a review of what CPTs have been added, subtracted, or redefined.  

I found Jan's answers so helpful that I've recorded them here.

Me: Jan, I followed your presentation about the 2020 changes and I don't know if you realize it, but I'm a little ADD.  Is this the year phone calls get RVUs?  Or did it already happen?  Can you start with your executive summary for what's happening in 2020?

Jan: For Peds in 2020 the important changes are around E&M and the Health Behavior Assessment and Intervention codes.

The Online E&M (or Assessment & Mgmt - A&M - for qualified non-MD Healthcare Providers) went from a single, episode-based CPT (96989 - now deleted) to becoming time-based beginning 1/1/20. The new time-based Online E&Ms do have RVUs. The Online A&Ms…not so much. But even those are an example of services that make your practice tick. When you have clinical support staff working at the top of their licenses, MDs/NPs/PAs are freed up to move the needle on that all important Well/Sick ratio. You know, the one where kids get healthier along with your bottom line? It’s billing for services like Online A&Ms which drives practice excellence and shows your patients the value of your entire practice’s expertise.

Can you give me an example of how and when these new codes should be used?
Jan: Just as the expired code 96989 was used, when a patient reaches out with a concern over the phone, let’s say a minor sunburn, and an RN follows a triage protocol and determines it’s not high enough risk to warrant an office visit, makes recommendations for relief, and that’s the end of it, the call(s) may be billed based on the cumulative time spent communicating with that patient using 98966 through 98968.  On-line or digital visits do not yet have RVUs for non-physicians but are billed using 98970-98972.
Me: Can we map out which codes are billable and which codes have RVUs?
Jan: Sure.  They are ALL billable, but the digital visits by non-physicians are the only codes in this arena without RVUs.  They have RVUs for physicians and when non-physicians make phone calls.  However, there are none for non-physicians doing online work.
CPT Code Description RVUs
98966 Qualified Healthcare Provider, Phone Call: 5-10 min 0.40
98967 Qualified Healthcare Provider, Phone Call: 11-20 min 0.78
98968 Qualified Healthcare Provider, Phone Call: 21+ min 1.14


Qualified Healthcare Provider, On-line Digital E&M svc: 5-10 min 0.0
98971 Qualified Healthcare Provider, On-line Digital E&M svc: 11-20 min 0.0
98972 Qualified Healthcare Provider, On-line Digital E&M svc: 21+ min 0.0

MD Online E&M: 5-10 min

99422 MD Online E&M: 11-20 min 0.86
99423 MD Online E&M: 21-30 min 1.39
99441 Physician or Qualified Healthcare Provider, Phone E&M: 5-10 min
99442 Physician or Qualified Healthcare Provider, Phone E&M: 11-20 min 0.78
99443 Physician or Qualified Healthcare Provider, Phone E&M: 21+ min 1.14
As for the Health Behavior assessments…The Initial and reassessments have been condensed into just 96156 and the minimum time associated with the Intervention codes is increased with add-on codes now available.  Here's a table of the changes.
Curiously, the 2020 Manual DOES NOT include the telemedicine *star* indicator for the 2020 codes. 
Me: What is the implication of that missing star?
Jan: Here’s an example of the 5 point star in use by the AMA.  Ignore the 96146 in this snap of the 2019 manual. These services were - but now are NOT -  recognized by AMA as able to be performed via telemedicine.

Me: So, you're saying that before 2020, these health intervention codes could have been coded properly in a telemedicine context, but not any longer?

Jan: Yes, it seems sad but true.