The American Medical Association (AMA) and the Center for Medicare and Medicaid Services (CMS) are paving the way for a dramatic evolution in the healthcare sector in 2024 and beyond. These changes will profoundly impact how healthcare practitioners approach patient care, especially regarding coding, radiology procedures, and confronting underlying Social Determinants of Health (SDoH).
AMA Introduces Revised Code Descriptors and a New Telemedicine Framework
The AMA has announced amendments to the Current Procedural Terminology (CPT) manual to modernize healthcare delivery and streamline administrative processes. The 2024 edition will incorporate adjusted descriptors for office visits (99202-99205 and 99212-99215), with the 2025 version set to introduce a new series of telemedicine codes.
These changes aim to align the healthcare sector more closely with CMS guidelines and alleviate administrative burdens. The main focus areas include adjustments to time ranges for office visit codes, enhancements to guidelines for split/shared visits, and increased clarity for reporting same-day and inpatient/observation services. All these alterations are slated to effect on January 1, 2024.
Insights into Data Definitions and Coding Changes
Two key data definitions are also set to change, with amendments applicable to medical decision-making for level-based E/M visits. The changes include guidelines around the assignment of data points when a provider orders and interprets a test and the consideration of documents from an appropriate source for data review.
Moreover, the 2024 manual will feature changes to coding for various office/outpatient visits and nursing facility codes, along with revised guidelines for a range of E/M services. The healthcare industry can also anticipate a significant revision to the telephone E/M code set by 2025.
Recommendations for Medicare Hospital Outpatient Prospective Payment System
Turning the spotlight on radiology, the American College of Radiology (ACR) has proposed recommendations to CMS concerning the assignment and reimbursement of new CPT codes for the 2024 Hospital Outpatient Prospective Payment System (HOPPS). The suggestions focus on codes for procedures such as percutaneous sacroiliac joint arthrodesis and non-invasive fractional flow reserve derived from a coronary computed tomography angiography data set. The ACR proposes to place these codes into the same Ambulatory Payment Classifications (APC) as their predecessor Category III codes.
CMS Rule Changes: A Step Towards Holistic Population Health
The CMS's commitment to a more comprehensive approach to health can be observed in its adoption of several rule changes set for implementation in 2024. The modifications, encompassing Hierarchical Condition Categories (HCCs) and removing specific ICD-10 codes, reflect a conscious move towards addressing Social Determinants of Health and care costs at a more fundamental level.
Specific adjustments include changes to categories related to diseases such as Diabetes with Chronic Complications, Protein-Calorie Malnutrition, Morbid Obesity, Major Depressive Disorders, Congestive Heart Failure, and Chronic Kidney Disease, among others. Other notable changes include eliminating drug-induced conditions and dialysis and increasing coefficients for conditions like dementia, severe mental health and substance abuse disorders, moderate CKD, pressure ulcers, and transplants.
With these sweeping changes set to effect from January 1, 2024, healthcare organizations must start preparing to ensure a smooth transition. A solid internal continuing education program can be instrumental in readying staff for these significant federal rule changes.
The upcoming changes highlight the healthcare sector's relentless drive towards enhancing patient care quality, simplifying administrative processes, and addressing health determinants more comprehensively. As the industry navigates these transitions, healthcare providers nationwide must remain adaptable and forward-thinking.