Hi everyone, we'll get started shortly as soon as everyone gets dialed in. Hi everyone and welcome to our first boot camp series. My name is Nicole Knight. It's great to be kicking this off this week with my partner, Jolene. I'm going to get us started on the 2025 CPT coding changes and the physician fee schedule impacts. We have a good bit of content today and we're going to get into it. I'm going to start with a couple of housekeeping slides. In the chat box, you'll find a link to access the slides and presentation. You can click that link and access those and download them. It should be in a PDF format and you can save those to your computer. Also, if you have questions as we go through the presentation on this topic, you can type those into the question and answer box. The entire RCS team is supporting us on the call today and, of course, Ari and Julie to help us with any technical questions. If you have any questions, you can type those in and we will answer those throughout the presentation in the question and answer box. Also, if we have time, it may take a couple at the end. If not, we will email those out as we always do or they'll be available to you on the academy portal. This webcast and all of the webcasts this week are worth 1.5 CEUs with AAPC. You will be able to download your certificates from the MedAxium Academy and that should take about one to two business days. Please at least give us a week since we're going through many webcasts this week, but your certificates will be there for you to download. There is a slide in the handout as well that shows you where you can claim your CEUs and how to log in and get those as well. I'm going to get us started with some evaluation and management updates. We're going to start with some telemedicine information that's effective on January 1st. If you attended the final rule webcast last week with myself and the ACC team, we talked about that telemedicine effective January 1st does go back to the originating site rules where the patient has to be located in certain rule or underserved areas, which would mean that if your patient is located at home, effective January 1st, you can no longer provide telehealth services. There are several bills under consideration in Congress that would extend and make this permanent for us to utilize telehealth the way we do it now with the patient at home in 24. However, we're not sure if those are going to make it through. If they do, it will probably make it through by the end of the week. If not, we probably won't know anything until after the first of the year. But hopefully there's some movement and we'll hear something about any impacts or changes to those bills that are in Congress by the end of the week would be wishful thinking. Otherwise, we may not know until January. As of January 1, as it stands today, on December 16th, effective January 1st, the site rules go back to that originating site being rule or underserved areas. Also, the patients, they have some clarifications about if the patient is using audio and video and they cannot use it or you don't have consent to use video, those types of things that you can document it. The provider must always have access to audio video. However, if the patient is unable to use audio video and you are able to utilize telehealth services, you can document that and bill it as audio video. The distant site provider, meaning our physician or APP who is doing the telehealth visit, does not have to report the address where they are located. Many question around if they were located at home, do they report their home address? They do say that it would be their enrolled practice address, so that was not changed and was mentioned as well in the final rule. But again, this goes back to that first point. If the originating site rules take place, we'll be going back to that pre-pandemic telehealth guidance. So, CPT, if you looked in your evaluation and management section, created codes for audio, video and audio only E&M services. These are the code ranges. CMS, in the physician final rule, reported that they would not pay for these audio, video or audio only calls. The only code that CMS will reimburse, that's in the CPT book, is the 98016, which is going to replace that G2012, the virtual check-in code. So, we'll talk a little bit about that. CPT did delete what we used to call the telephone or call the telephone codes audio only, so the 99441 to 99443 is no longer active and they return to a bundled status anyway by the end of the year, according to telehealth, but CPT did delete those codes. CMS did report in the final rule that there will be more to follow on telehealth services. Everyone is asking about commercial payers. I think that's the big question. Like I said, until we know if that distance, if the originating site for the patient changes and goes back to pre-pandemic, not sure how much telehealth will really be happening next year, which is unfortunate, but I'm very hopeful in the legislation that's moving forward, we'll still give our patients access to telehealth services and some of that audio, video support and some other things, so we'll have to stay tuned on that one. This is the 98016, and like I said, this replaces the G2012 for Medicare as well. It's a new code in the CPT book. It will be recognized and reimbursed, and this is that code we called the virtual check-in code, has the same language as the G code, and that is going to be reimbursable by Medicare. This is from the final rule. Basically what Medicare did, I've had a lot of questions about why won't CMS cover the new CPT codes for audio, video? Well, there's several dynamics around face-to-face visits and other legislation, but when you look at the crosswalk to our current new patient codes and our current established visit codes, basically when they did the comparison, they said they're the exact same thing. In most cases, there are some that are a little different, and they felt we have these codes established as well as what is required for these codes, and they felt that they did not want to adopt a new code set based on that, and that's why they reviewed it and basically said based on if the patient has a face-to-face visit, what the definition of an E&M service is and how these compare, they are not accepting these new CPT codes, and we don't know what commercial payers will do yet. As you get that information, it'll be great to share that on the Listserv as everyone is navigating through this, so it'll be very important if you get information from your carrier in your region, if you share that information on the Listserv, that would be awesome. This is around audio only, because we get questions, how are we going to build telehealth on January 1st? Well, as I tell you today, for December 16th, if the patient has to be located at an originating site that is a rural or underserved area, so it goes back to pre-pandemic, so that's going to dictate everything. If you meet that, they do recognize audio-video services, the provider must always have access to audio-video, and this talks about what they expect if it is an audio-only, since the deletion of the codes for audio-only and them not accepting the new CPT codes, they talk about an appropriate modifier that would be used to identify that the service is being furnished via audio-only. Now, this is going to require further information from CMS, which they acknowledge that they will be providing, because the modifier we have now for audio-only is truly for rural and underserved areas. So as we watch for these updates, I think it's, like I said, some people are like, well, do we stop doing telehealth on January 1st? Do we continue? I think you're going to have to make that decision as an organization as this continues to move, and hopefully, maybe we'll get some insight before the end of the year, which would be great. As a reminder, cardiac rehab, that requires direct supervision. You can meet those requirements by being immediately available by the supervision practitioner through audio-visual through 25, so that was good news, and then also our cardiac rehab services remained on the telehealth list provisionally through 25. So this was good news from a cardiac rehab standpoint. For the G2211, the add-on E&M complexity code for office or outpatient services only, this was approved effective January 1st, 25, that they now can be billed with an annual visit, vaccine administration, or preventative care services. Now, there were many questions I know on the final rule webcast, well, if modifiers 25 must build, can we build G2211 now? No, that has not changed. If your evaluation and management service qualifies for a modifier 25, and it's a distinct and separate service from a procedure diagnostic that day, and you have to append that modifier 25, the G2211 is not billable. So when you look at the application of modifier 25, which I feel like when we implemented G2211 this year, several things came up about this is variable by payer, region, and organization, and it's important to reference your NCCI edits and your local Medicare carrier, because we get questions all the time, well, do I have to put a modifier 25, for instance, if a patient has an EKG? That is going to depend on your carrier, and many carriers do require that, but again, it's so variable by region and payer, and also if your organization has regulatory compliance policies or if you're following NCCI edits only or local Medicare, that is variable, so you do have to consult with those resources regarding that application of the modifier. So global payment policy, so this, again, was around an accuracy effort, Jolene's going to take us through on a boot camp tomorrow, I believe it is, around modifiers and global surgery. I'm touching on what was in the final rule, so modifier 54 is required for all 90-day global packages, in any case when the practitioner plans to furnish only the surgical procedure. What has changed is that it does not require a transfer of care, and your payment will be adjusted when it is applied. More about these modifiers on Tuesday. On the new post-op add-on code, which I see we have a little typo right there, the G0559 was created to address the resources used when post-op care is provided during the 90-day global by a practitioner that did not perform the procedure and is of a different specialty and practice. It does not require a formal transfer of care agreement. This is a CMSG code, and it has a work RBU of .16. This code captures the additional time and resources spent in providing that follow-up post-op care by the practitioner who did not perform the procedure. It's billed once with a related office E&M during the post-op period of 90 days. They do believe from a Medicare physician fee schedule standpoint that the uptake and utilization of this new code may be slow, similar to our G2211. It's been a slow transition in billing that. I think they believe it will be slow as they continue to collect data in this. As you look at the Medicare physician fee schedule, they talk about the 99024. What they do to clarify in the final rule is state that you should not be reporting the 99024 if you're in a different group practice than the procedure list when billing for post-op care. This contradicts because I think many of us bill that 99024 potentially if we are in a different group from the procedure list. This is a clarification as they're continuing to define when you're going to add the G0559. Always, it has to be for significant service that is medically reasonable and necessary outside a global package. It's standard Medicare rule. You're still going to be billing your E&M service if it's significant and separately identifiable. Then, if you're providing that post-op follow-up visit that's inherent to that service addressing the surgical procedure. This is the description of the G code. I think the biggest thing I took from this, I'm not going to read all this information, was that the following elements should be performed when possible and applicable. When you look at this and you think about what has to be documented to bill this G0559, this is the things that they talk about. Reading the available surgical note to understand the relative success of the procedure, research the procedure to determine expected post-op course and potential complications, evaluate and examine the patient to determine whether the post-op course is progressing appropriately, communicate with the practitioner who performed the procedure, any questions or concerns. You can see it talks about this is listed separately in addition to your office evaluation and management visit. If you are performing these, and remember, you are of a different specialty than the practitioner and not in the same group. I think this will be slow. I know I've talked through this with the RCS team and we've said, I don't know exactly how this is going to apply. It talks about different scenarios where it could apply. I think they updated the global surgery information packet with the modifiers. I think we'll see more information about this. But this is all around collecting data around that post-op period. I think that's why they feel the uptick will be slow as you continue to figure out how the services are going to be billed and what this looks like in your practice, particularly if your program, you have cardiothoracic surgeons, for example, and cardiologists, interventionalists, those types of things. So our ASCBT risk assessment and management codes, these are also new CMSG codes that have been created. Consent is required. And these have .18 work RVUs assigned. The first code, the G0537, covers the administration of a risk assessment for cardiovascular disease. And they give examples of what that tool is. It can be the ACC's estimator tool or AHA prevent tool. This is stemmed off of our Million Hearts program, if you participated in that. The assessment done on the patient that does not currently have a CB diagnosis or a history of, and they give specifics, heart attack, stroke, so on and so forth. And they give some examples. The G0538 is a risk management service code that would be reimbursable on patients without a diagnosis found to have intermediate, medium, or high risk for CBD. So the first code, I don't necessarily see cardiology using as much, but I could see the G0538 for the management services. If they're seeing a patient that doesn't have a diagnosis, and they may use that risk assessment tool, and it includes that management and determine, because you still have to have the risk assessment in order to determine what those management services would be. So here are the code descriptions. So the G0537 is administration of the standardized test or assessment, and it's a time-based service for 5 to 15 minutes. And I do apologize for my barking dog. It never fails that Amazon, UPS, or FedEx are delivering at this time. So I apologize. So I apologize. It is a time-based code. It's not more, billed more often than every 12 months. Then when you look at that G0538 code, it is per calendar month, and it talks about exactly what this covers and what has to be covered within some of the documentation for that, and that it can be billed by the practitioner per calendar month for that patient. So when you look at these codes, I anticipate, just like many of our other codes, when they're new, we'll get some additional guidance, but it does cover the administration of that risk assessment tool, and you want to be sure you're using one of those recommended tools. And remember, the management code for the patient who has risk of that intermittent medium, but not a diagnosis, the G0538 has no minimum time threshold, but you have to document each service element that was within that code, which as you can see, it talks about what that a care plan is established from the risk assessment, implemented, revised, monitored, and addresses risk factors, enhancers, and incorporate shared decision making of the practitioner and the patient. So although it doesn't have a time requirement, there are some documentation requirements, and I anticipate we'll see some additional information from that as well. Just like any other code, these do require consent, because it does have a patient out of pocket expense to them. If they only have Medicare, you know, and not a secondary, they could have an out of pocket expense. I'm not sure about copay information, but I'm sure it's going to be variable, but that is what part of that consent is for, to inform the patient of a potential out of pocket expense. All right, so I'm going to let Jolene cover our surgery, radiology, and medicine updates, and then I'm going to pick back up shortly. Jolene, are you there? I sure am. Thanks, Nicole. All right, go ahead and hit the next slide. So first I want to talk about some new wound care autographed. Now keep in mind, autographed means it comes from the patient. This will mainly be seen with vascular surgery, but I could see where maybe some CT surgeons get involved as well. And those of you that have general surgeons, they could also be doing this. But these are new codes for wound care, and it's using skin cell suspension autograph. So the first two codes, the 15011 and the 012 are for harvesting that autograph. And the first one is with the first 25 square centimeters or less. And then the 15012 is for each additional 25 square centimeters or part thereof. So they don't necessarily have to have a full additional 25 square centimeters. They just have to have more than the first 25. You're also going to want to check MUEs on this come January when you run your codes through NCCI edits, and it'll let you know how many of those you can bill. So for the next set, we have 15013 and 014, and that's for the preparation of the graft itself. Again, it's split out by the first 25 square centimeters, and then the each additional. And then, you know, you're going to use the 15014 in conjunction with the 13. The next two, the 15015 and 15016, are actually application to the donor sites of either the trunk, arms, or legs, or it could be all of them. But note, this is for the first 480 square centimeters or less, and then you have each additional 480 or part thereof. One thing I want to point out, if you're new to coding, the way you find your square centimeters is multiplying the length and width of the wound. And then, that being said, it's very important that your providers actually give you the exact wound sizes. That's one thing I see a lot of in the groups that we code for and that we perform audits for. A lot of the providers are not specific, and you need to have those conversations because otherwise you'll have no idea how much to bill, and, you know, good enough size wound, they could be shorting themselves on RVUs. Next slide. And then this is rounding out, again, this is the application of the autograph, and this is for the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and or multiple digits. And again, we're looking at the first 480 square centimeters or less. And then the add-on code for anything above 480 square centimeters. Next slide. So for CT surgery, we actually didn't have a lot going on here. Unfortunately, I will tell you, we did not get a new code for the branched endograft in the thoracic area. I don't know if maybe one will come out later in 2025, but we did not get one for January. But that being said, so we had two codes that were actually revised. The first one being the 21630, and it basically now states radical resection of the sternum. They did delete 21632. They also deleted the valvotomy pulmonary artery via closed heart. That is deleted. They also deleted the atrial septectomy of septostomy, or septostomy, not of, and the obliteration of the aorta pulmonary septal without cardiopulmonary bypass. And then 33814 has been revised, and note that it states with cardiopulmonary bypass. So basically what they're saying is the obliteration of the aorta pulmonary septal defect has to be done with cardiopulmonary bypass now. So that's what the revision on that is for. Next slide. So now we have a Category 3 code, our favorite. As you know, they are set by, Carrier sets the price on that. There are no specific RVUs associated. But for this one, it is a esophagoscopy, flexible. It's transoral with an initial transendoscopic mechanical dilation. The first one with a non-coated balloon, non-drug coated balloon, followed by therapeutic drug delivery by a drug coated balloon. And this is being done for esophageal stricture, and it will include fluoroscopic guidance when performed. Next slide. And actually go one more. So next we're going to talk about some radiology section updates. These are a new set of codes for MR safety for implants and foreign bodies. So this is for people that have certain implants. And as you know, with an MRI, there's magnetic. It's done by a large magnet. So we have to be careful of people with implants and any foreign bodies. I do want to point out that 76014 and 76015 do not have any WRVUs assigned. So there's no work RVU for that. It is done by trained clinical staff. And then the rest of the codes do have RVUs, and I'm going to cover them a little bit in depth in the next slide. Go ahead, Nicole. So for 76014 and 76015, these are technical components only, and they reflect the time that the trained clinical staff identify and verify any implant components and review what the MR requirements are for those implants. They will contact the patient, give them instructions prior to the MR exam, and then, of course, this will have to be documented in the patient's chart. For 76016, this is not anticipated to be used routinely, and it is to be used where MR requirements may not be clearly defined. And then the MR does present a risk to the patient of the diagnostic utility of that MR exam, and they could be compromised by the presence of the foreign body. From 76017 to 019, that will include the work of the physician to ensure that the patient and the patient's implant are protected. Codes 76017, 018, and 019 are modular, and they can be built together if the implanted devices require more than one service. Next thing to point out on this is for anyone that has a cardiology cardiac device, such as a pacemaker, defibrillator, that requires any interrogation or programming either before and or after the performance of the MRI, you're going to want to report those cardiac device codes appropriately. So whatever the case may be that the patient, whatever type of device they have, you will report that separate. Next slide. And you can go one more. So we only have one medicine code change, and it's actually a revision. So this is for the PBI code text for the AFib ablation. So comprehensive electrophysiological evaluation with transeptal cath insertion, repositioning of multiple electro catheters, induction or attempted induction of an arrhythmia, including left or right atrial pacing and recording, and intracardiac cath catheter ablation of AFib by pulmonary vein isolation, including intracardiac electrophysiologic 3D mapping, intracardiac echocardiography with imaging supervision and interpretation, right ventricular pacing and recording, and his bundle recording when performed. So obviously I didn't read the parts that are marked off. That's what the revision is. So they've deleted those words that have the line through them. So let's talk about that a little bit in the next slide. So basically what we're talking about here. So as you know, ablation procedures 93653 through 93657 are performed at the same session as an EP study, and the codes themselves represent that combined procedure. We don't code the EP study separate when we do those ablations. So the 93619, the 93620, any of those separate component codes, we do not code those separately. Whether we're talking about the VT ablation, SVT, or the AFib. Now the 93621 left atrial pacing and recording from the coronary sinus or the left atrium is also not reported separately with the 93656, which is our AFib ablation. Codes 93653 and 5.4 include right ventricle pacing and recording and the his bundle when clinically indicated. The 93656 includes those plus the left atrial pacing and recording. So you're probably like, why are you telling us all this? Well for 2025, if one or more of those components is not possible, nor is it indicated, your provider must document the reason for not performing that component with the ablation. So it's very important that you have this conversation between now and January 1st, because if for whatever reason, let's say they can't do the bundle of his, then they need to document that, why they didn't perform it. You don't have to reduce anything, but they do have to document why it's not performed. Where before the language would read, you know, when performed. Now they want to know why it's not being done. So that's very important. If you forget everything else I said in the last 10 slides, don't forget this one. Jamie will have my butt if you guys don't do these correctly. So anyway, that being said, I'm going to turn it back over to Nicole, and she's got a lot of Category 3 codes to go through for us. So thank you. Thanks, Darlene. Yeah, so it's interesting, you know, when we all as coders get our new CPT books, we're always looking at the code changes. I would have to say, even though the final rules were not as impactful when you're reading content and interests for changes. So I think we're getting to that point. We have minimal changes. But this is one section that I feel is continuing to grow, and that's our Category 3 codes. And these are our T codes that are those temporary codes that we call. As a reminder, any code that has a T that's a Category 3 code is not assigned a work RVU or a fee. Each Medicare carrier based on your contractor will carry or price these codes and determine coverage. Commercial carriers and even some Medicare Advantage plans may or may not cover these services. They may be considered what we see on our denials as investigational. This is an ever growing area because normally these all represent technology or new technology in our space. So we're going to talk a little bit about that. I do not know and I'll tell you from the RCS team and in working with the CTS guru in this in the imaging space as well, Jamie, we have kind of gone through these and looked at some examples. But as I go through these, it's important, number one, if you don't have a policy on when they start doing something new, I always say the last people to know are usually revenue cycle. We should be the first people to know. So I would have a policy established if they're going to begin using some new technology that definitely revenue cycles pulled into it. So you have some knowledge about this, because this starts with work RV, I mean, this starts not just with work RV use, it starts with authorizations and approval and patient out of pocket, all of those things. And as you'll see, I, as I go through this, many of these are very confusing and it's like, okay, I got to figure out, does this device really fit that criteria? So our first code, and these were released in July, but they have effective and published dates of 1-1-25. This is a drug coated or drug eluting balloon that includes mechanical dilatation and delivery by balloon angioplasty. You can see what's included in that of a single major artery. And then we have an additional code as well. And these are used in conjunction with our, for additional add-ons, you can see what is used and what they're used in conjunction with, and what they can't be reported for on the same targeted lesion in the same coronary artery. So if your physicians begin using these in the lab, understanding what they are and what they're doing and when they can be billed will be important. And again, that reimbursement piece is up to your carrier. These are some of the new codes. So we have a new abbreviation, which is always fun, CCMD for our device implants. And this is an example, could be an Optimizer Integra CCMD system or a smart system. This is a single device that combines ICD and cardiac contractibility. So when you look at our CCM, another abbreviation, that's where that comes from, cardiac contractibility. This is used for patients with class three heart failure who have left ventricular ejection fractions ranging from 25 to 45%. The CAT-3T codes are for insertion, removal, interrogation, and programming, and even EP evaluation. So there are 17 codes in this particular category. So I have them on this slide. Of course, they're in your CPT book, but as you can see, it's the same as kind of our device codes where it has single, dual, where it has pulse generator only. We have programming, repositioning, relocation, interrogation, and then even EP evaluation. So if your physicians are utilizing this, again, this is a new device in our EP space that I'm certain we'll see eventually. Monitoring service. Now this one was confusing for me as I started to read this one, I was like, okay. So another consideration for the many products and vendors. So new codes for our external ECG recording for greater than 15 days and up to 30 days by continuous rhythm recording and storage. It's 09317. They specifically say this is not mobile telemetry, that this is similar to our patch codes that have CPT codes for 48 to 7 days, 48 hours to 7 days, and then 7 days to 15 days. So this is filling the gap 15 days to 30 days if you're using those patch monitors. And this breaks down, you have your global code, then you have your recording code, your scanning code, and then review and interpretation depending how you're billing these services. So with your patch monitors, if you're billing these timeframes, another layer to add to that as well and to determine the coverage of that. They do have an index now in our CPT book, it's called Appendix S, and it's around AI. I know we all hear about AI around in our space of the revenue cycle, particularly coding and billing, there's several different aspects of AI. So when I saw this in the CPT book, and we're going to talk about a couple of codes here, I think it's important to understand each of these. And as you look at technology being brought into your program, then you can also determine which definition it fits. So there's three categories that CPT talks about around the AI space. One is assistive, which is the work is performed by the machine for the provider. The machine detects relevant data without analysis or generated conclusion. And it requires a physician or QHP interpretation and report. For augmentative category is when the machine analyzes or quantifies the data and it yields a clinically meaningful output. And this also requires a physician or QHP interpretation and report. When you look at this, and I'll talk about our last category, autonomous, they did put this in the CPT book in the index that talks about so what does this even mean, Nicole? So primary objective of assistive, you can see they have like the definition provides independent diagnosis and our management decision. So you can see if it's no or yes, analyzes the data, requires an interpretation or report, and it gives some example category three CPT codes that would fall into these categories. So I think this is a helpful table as you look at the definition of these products. Our third category is autonomous. And this is where the machine automatically interprets the data and independently generates clinical conclusions without concurrent provider involvement. So it can include interrogating and analyzing data. It has an algorithm that may include acquisition, preparation, and or transmission. And it develops a clinical meaningful conclusion that can be categorized as data to establish a diagnosis or implement an intervention. Then they even take this category further, where it breaks down the three levels of this autonomous AI that draws conclusion and what it means. So again, I think this is a good reference as you look at different products. And as we talk through the remainder of our category three codes and cardiology impacts, this one is just an update. So CT coronary plaque analysis, we've had some category three codes, our current codes that we use, and officially they're going to convert these two category one CPT codes next year. So it's going to go through that AMA RUC reimbursement with proposed reimbursement in July of 25. And you can see also when you look at our example of the CT coronary plaque analysis, many of our Medicare carriers are releasing LCDs for these current codes. So five out of the seven carriers have released these. So if you're doing CTA and you're doing plaque analysis, you want to look at those coverage policies, but at least we know that we will get a CPT code for this one in January of 26. And it's going to go through evaluation and reimbursement in next year as well. So that was some good news. Here's a couple of other codes that may be relative if you do a duplex scan of a hemodialysis fistula, computer aided. And then it also goes through some other codes for blood oxygenation and for CT imaging around some interstitial lung disease. They do have some category three codes in this space as well that may be relevant. When you go to these, these are around our cardiac arrhythmia stimulization. So these can be in relation to EKG services, but they're not add-ons that can be reported with EKG services. So you can see the first code talks about that augmentative analysis of an arrhythmia and it's derived from simulations based on intervals of interest from a 12-lead ECG and up-bladed parameters. So this is actually a vendor equipment. So it's some examples I found, or an example I found was VMAP by Vector Medical. So that may be one that you run across, but again, this can't be built in conjunction with the 12-lead EKG. So again, understanding that equipment and what services it's providing and what it's giving you and how to build that. And then that second one, this one, some examples were pulse AI, or there are some Medtronic GE products I saw, and this is a QTC interval derived from that augmentative algorithmic analysis of input form and electronic patient activated mobile EKG device. So again, can't be built in conjunction with our EKG codes or rhythm strips for this one, want to make sure if you're utilizing this in your programs that you're building this correctly. And it's meeting all of the code requirements, they do break down as well. By if you're doing the tracing and interp only for this particular code, a potential example here, there wasn't much out on this one online is AliveCore Accordia's 12-lead EKG system. So again, you want to see is it a 12-lead system? Is it particular equipment software you have that's now performing this? Because it's not something that's reported in addition to your EKG services. These are also some codes for blood flow analysis, myocardial blood flow analysis for MR. So if you have an MR program, this can be added on to the 75563, which is the an MR code with stress, I believe. So it is built in conjunction with that. These as well are add-on codes. So understanding that it's an add-on code versus it's not. And then the difference between these two, I found interesting as we looked at that, that section in CPT was one is augmentative, and the other one is assistive. So knowing when you're using that and when you're not using, which one you're using at the time of MR, of your MR, and if that's supportive of it, I think is going to be important. So really spending some time with your technologists, your physicians and understanding if you're using this technology and what that reporting looks like. ECHO is another space that we're seeing these. So this is one that you can build in conjunction with your ECHO services. So limited ECHO, complete ECHO, stress ECHOs. These are some potential examples. iCardio AI is one, DIA imaging, MyCardium AI. So you'll be seeing some of these in your program. Again, that's that augmentative analysis of a report. So it requires an interpretation from a physician or qualified health professional and build along with your ECHOs. And this one is for the non-invasive detection of heart failure. And it's looking at that preserved ejection fraction on ECHOs from that augmentative analysis. Heart failure monitoring. These are category three codes that cover the first one is transcatheter implantation of a wireless left atrial pressure sensor for the long term left atrial pressure monitoring, including calibration deployment, and includes a right heart cath, a transeptal puncture as well. So we may see these in the cath lab. And then also the remote monitoring of that sensor here. This one, you can see the potential example that I found for this one is VLAP system. And that's not all the examples. Like I said, we, we tried to research and look at examples of how these are used and what they're used for. This is one you may see in your programs, again, around heart failure or depending on on your program, if if you can see what codes these are not reported with. And then it also tells you if you're doing the implantation of a wireless pulmonary artery pressure sensor, then that's when you go back to your 33289. So you want to be sure that you're reporting the right service based on the procedure that's being performed. And these are focused on that heart failure monitoring system. Right. So far, just some reminders around reimbursement. So for 25, the physician fee schedule conversion factor is reduced by 2.83%. There's also bills in Congress to stop that reduction as well. It is on the end, hopefully, again, you know, we kind of go through this cycle every year where we may hear by the end of the year, we may not know till mid January, February, watch for your fee schedules, watch for any emails that are coming through from the listserv MedAxium and the ACC. When you look at the overall reimbursement for cardiology, what I would say is we do publish a fee schedule calculator with the ACC publishes and there's a link as well in the presentation at the end. If you go in and plug in some volumes, you can see with this conversion factor and with your location, if you put in your gypsy, you can see what your potential impact would be based on the services you provide. So if you wanted to look at echoes or nukes or CTs or your E&M services, you could go in and plug some numbers in and it'll tell you the difference year over year if this reduction stays in place, which services would be impacted. So if you haven't gotten, which many of the fee schedules may not be posted yet, I'm sure. If you haven't seen a fee schedule and haven't done a comparison, that's a good way to do a comparison. So you can see what's impacted. When you look at everything in totality, the impact remains flat, but it truly depends on the services and population that you're serving. So what services are you providing? And where do those cuts factor in? And what does that look like for your organization? Right. For outpatient hospital services, I did want to mention for outpatient hospital, there is an increase. So in some cases, we'll hear, well, this diagnostic service, we heard that there was a drastic increase to the payment for the facility. Well, when that happens, that's under the outpatient hospital system. If you're billing based on outpatient hospital place of service, or you're doing provider-based billing, there may be an increase on that technical side or facility side. But the increase on the physician fee schedule, you have to look at that fee schedule for the physician side to determine for that interpretation and review and that piece of it what the reimbursement is. So there were some wins in this space for CTA, and a couple of other areas, PET, where the HOPs payment did go up, and there was somewhat of an incremental, in some cases, increase on the physician side, but a large increase based on how our outpatient hospital systems are paid by APC. And you will see that and hear that there's some reimbursement impacts on that side of things, as opposed to on the physician fee side, there may be some incremental changes and increases. But the significant impact on some of those diagnostic services is truly on that outpatient hospital facility side. Here are some helpful links. The first one is to the physician fee schedule. And when you go to these links, they're both posted on ACC and MedAxium. It even drills down to the fact sheets. It also drills down to the final rule that's posted in the Federal Registry. If you want to look at the pages, I can tell you the easiest thing to do a lot of times if you're looking for specific language and want to understand what they're saying, in detail, you can go to that Federal Registry, type in the code, and it's going to take you to every section when you do a find where that code's located. So if you want to look at that specific language, that's one way to do it and look at exactly what they're saying and all the comments going back and forth. And then this last link is to the physician fee schedule calculator that the ACC has put out where you can plug in your gypsy and also your volumes and look at what that impact is. Our next session will be tomorrow. And that is on navigating modifiers and the global surgery package and some documentation tips. As you continue to go through the week, we'll talk about advanced EP studies. And then Thursday, we'll get into non face to face coding and documentation opportunities where we'll cover care management, RPM and a few other areas where you may not be thinking about that non face to face coding. So as we go through the week, we hope that you find these valuable and that you gain insights. I'm going to take a moment and look at some of our questions since we have a little bit of time. I knew you all were going to ask and test me on is this T code this is this T code that so is this T code for echo go? What I would tell you is I don't know the name of all the vendors and the codes that apply to each and every one of their tools and what the functions of their tools are. I think just as we do going and researching and looking at exactly what that does and really understanding number one, what is the software? What is the device? What is it providing you and what are the requirements and really mapping it to those category three codes? I wish I could answer all those for you. But I'm not I think when you look at this technology piece and you look at all the information out there, it's pretty hard. The cardi I will tell you there were references to the 0903 T to 0905 T for the cardio 12 lead. So I don't know if that's a different product than the cardio where you put your two fingers on, you know, again, I think those you're going to have to look at. As you look at those T codes, unless Jolene you have a looking glass that's going to tell you I know I did a lot of looking when Jolene and I went through these codes, we were like, wow, there's so many temporary codes and being able to go through and look at exactly which device that goes to I don't know, Jolene, did you have anything to add into that? Not on the T codes per se. And, you know, again, it's, there's a lot out there. And it's hard for us to keep up with all the vendor technology that's coming through. So I'm we'll know more in January. I mean, we hate to say that, but there's a lot of this stuff is brand new to us as well. Yeah, I do have a couple of questions I can answer to that. Yeah, I was gonna let you go Jolene on some of those give your opinion on some of the globals. I know I answered some of those, as well as typing through but I kind of stay away from those surgical cases and modifiers. So I'll let you take those. All right. So on a on a couple of those, basically, we're looking at it's not by taxonomy with that transfer. Well, it's not technically a transfer of care. But if a surgeon and I don't think you're going to run into this a lot. But if a surgeon for whatever reason is not going to continue the post-op, then you will not build like the the 99024. You won't build up global code, because they're not performing that. I'll get in tomorrow, there's some more with the the 54, the 55, the 56, all those modifiers, we'll talk about a little more tomorrow. But just keep in mind, you know, you're looking at a totally different practice. So I where I had seen before in the past, would be like if I was out of town, and you know, I had a heart attack, and they ended up doing a cabbage, and then I come home, after having that surgery, well, I would see a surgeon, that, you know, a CT surgeon where I live, and they would take over that post-op care, even though they didn't perform the surgery, that's where you see a lot of this. And then, you know, or, or if you have a surgeon that's, that's leaving, and, you know, he's going to perform his surgeries up to, you know, whatever date, and then from the 90 days after that, he's not going to be around, then you, you know, then you're looking at a different provider in that case. There was a couple of questions too, around the autograft skin cell. One of the questions is, what is it? Well, it's basically the harvest of the patient's skin. They do, they do a prep around that, and it actually ends up being a spray-on. It's usually used in thermal burns, traumatic avulsion, any surgical excision of necrotizing tissue. It can also be used with skin cancer. Another question that came in is, are the debridement codes, the 11042 through 45, or debridement, depending on how you pronounce it. Basically, if there's gross contamination that that requires prolonged cleaning, you can build those separately. You can also build the other autograft codes if they're done. So, you know, just just kind of a little more on that with that new technology. And then I did have one other one, Nicole, I want to tackle here. The question was asked, why is this new requirement for the 93656? It's not just the 93656. They also have to document too, on the SVT and the VT ablation, if they're not performing those components. I, we have no idea why they came up with this, but it is in the CPT AMA guidance. So the comment was, you know, providers respond better if they know why or what's the reasoning. We honestly don't know. But you know, our suggestion is to share that language from the CPT book with your provider. And it is on page 818 of the 2025 professional CPT book. Yeah, and I think for that one, I think as coders, sometimes we overthink it, it's really just a language change. And I know something I read talked about, it's just saying the catheter has to be in the atrium. Well, if they're doing a PBI, they're doing for atrial fib, it's gonna be there. So I think we have to think of it not as literally as it's not, you know, if it's not documented, it's not, you know, we can't build a service. I think this is around education, and ensuring that the providers know exactly what's included. And in those rare cases where they're not including something that they're documenting it, because the code is still covered, it's just they need to document if they're excluding a portion of the procedure. So please don't downcode our EP physician services for that. But just know it's a wording change, let your physicians know about it, have them be sure that they're documenting clearly. And if they're using old templates, which is sometimes what we run into for EP, where they use the same template for years and years and years, that you know, their templates are covering that and just provide that feedback. So there were some questions around the risk assessment codes. So one was around who should be billing this code, I will tell you in the final rule, a lot of it commented around for the code for the assessment, that was the the time code where you're actually providing the assessment tool. This is for a patient who has a history of, or that type of thing. So they would not have a current diagnosis of coronary vascular disease for that code, or the other code, the other code is risk. So the one is the assessment, they have a history or they have a risk of CBD. The other is the management, because they're at either their risk has been quantified as intermediate, moderate, whatever it is, minimal risk, and they have a care plan. So it's important to note on those they don't have confirmed diagnoses of CBD. So that's where we get at will the utilization be low for cardiology, because by the time they get to the cardiologist, they either have it or they don't. One of the interesting things I brought up and talked with with the ACC as well was, you know, our ones we see that have an abnormal calcium score, I see those a lot now that you know, our CTA programs, well, do they have coronary disease? Do they not have coronary disease? Are they at risk? Is that a particular diagnosis that we could be doing this assessment and management, and it's not black and white or clear, I think we'll get some more guidance on this. But again, just making sure that the documentation is not that they have current cardiovascular disease, but in looking at those codes, it's the history or risk and the specifics around that for what they're looking for. Jolene, do you know anything about the drug coded balloon angioplasty? I have not seen any of those. So I can't really comment on that. They did have on there what codes it can be added with and which ones it can't be billed with within the same artery. My understanding is this is a specific balloon that is drug coded used for this particular procedure. So you're going to know if it's that particular device, but I don't have any other information on that. I don't actually at this time either. As we get it, we'll definitely provide additional information. Normally, we get a lot of that once they start using it. So once they start using it, and we start digging in for telehealth. So yes, no current CBD diagnosis for those risk assessment codes. So if I'm confusing you, it's history or they have risk. So they would not have a diagnosis of CAD if you're doing that. So telehealth, what about video visits with patients? Are we still able to build those with regular CPT codes? Well, we talked about that in the beginning, unless the literal act of Congress happens, it goes back to pre pandemic where the patient has to be located at an underserved rural site. And CMS does publish on the telehealth list, all of the CPT codes that can be billed. And our regular visit codes are still on that telehealth list. But the changes around if it's at the originating site, and then also there's some changes around the language of if it's audio, video, and the telephone codes have gone away. So looking at that updated CMS approved telehealth list gives you all of the CPT codes that can be billed as telehealth. But what we're talking about on January 1, without that act of Congress, it goes back to pre pandemic where it had to be rural or underserved areas. Am I missing anything else? I know there's a couple around the category three codes. But I think like I said, that's just continue and continue to share names of products you start using and how you're using them and how that's working in your practice. I think we all learn from that. I know in the AI space, even when you talk about AI coding, and what that looks like, and how that translates, and we have AI documentation. So we have AI around software, actual equipment, then we have AI documentation for physicians, and then we have AI coding AI claims technology. So really understanding what you need and what you're using and and sharing that information with your peers is great help. And we will also compile these but note that with the you know, end of year approaching and holidays and all that we probably won't be getting any of that out until mid January, but by then we would will hopefully have more information. So, you know, you guys ask great questions, and we do our best to to compile them and get them answered. So and speaking of which, I'm still working on the November webcast, I've just had a lot of things going on. So but I will get them out there. Yes, and we appreciate everyone's time. And we look forward to seeing you all this week. Thank you very much.

CPT coding changes

physician fee schedule

telemedicine

evaluation and management codes

telehealth services

category three codes

cardiovascular analysis

autonomous AI systems

surgical updates

radiology updates

legislative changes