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New Principal Care Management Service Codes Available January 1, 2022
While the next phase of significant revisions to the E/M code set is not slated for another year, a new set of principal care management (PCM) CPT codes will bring opportunities for neurologists and neurology APPs to report their time spent managing the care of a patient with a single high-risk disease. The PCM codes differ from existing care management services which require the management of multiple high-risk conditions or diseases. The AAN is pleased with the addition of the new codes as our members often treat patient with a single condition that requires significant care management activities. Effective January 1, 2022, four new codes will be available: two for reporting physician time and two for reporting clinical staff time: 99424: used to report the first 30 minutes provided personally by a physician or qualified health care professional (QHP), per calendar month +99425: used to report each additional 30 minutes provided personally by a physician or other QHP, per calendar month 99426: used to report the first 30 minutes of clinical staff time directed by physician or other QHP, per calendar month +99427: used to report each additional 30 minutes of clinical staff time directed by a physician or other QHP, per calendar month As is the case with existing chronic care management services, PCM services can only be reported when certain required elements are met: One complex chronic condition expected to last at least three months, and that places the patient at significant risk of hospitalization, acute exacerbation or decompensation, functional decline, or death The condition requires development, monitoring, or revision of a disease-specific care plan The condition requires frequent adjustments in the medication regimen and/or the management of the condition is unusually complex due to comorbidities Ongoing communication and care coordination between relevant practitioners furnishing care
Coding tips to keep in mind when determining if the new codes are appropriate for your practice include:
PCM services are reported for total time per calendar month. 99424 and 99426 are reported only once per calendar month. PCM services less than 30 minutes in a calendar month are not reported separately. 99424–99427 may be reported by different physicians or qualified health care professionals in the same calendar month for the same patient. Documentation should reflect coordination among relevant managing clinicians. Visit AAN.com/EM for additional E/M coding resources.
Be Aware of QPP Changes for 2022
The Centers for Medicare & Medicaid Services released its updates to the Quality Payment Program (QPP) for the 2022 performance year. Here are the key changes to keep in mind as your practice prepares for 2022 participation in the QPP in either the Merit-based Incentive Payment System (MIPS) or Alternative Payment Model (APM) tracks. Performance in 2022 will affect reimbursements on Medicare Part B charges in 2024. Merit-based Incentive Payment System (MIPS) Track Merit-based Incentive Payment System (MIPS) eligible clinicians must achieve 75 points to avoid a negative payment adjustment. This is a significant increase from the 60-point performance threshold in 2021. To be eligible for an exceptional bonus is 2022, participants must achieve 89 points. The maximum payment adjustment for the 2021 reporting year is +/-9 percent, the same as 2021. The MIPS Quality component will account for 30 percent of the overall MIPS score, down from 40 percent, while the Cost component will increase to 30 percent of the total
MIPS score, up from 20 percent in 2020. Several updates to the MIPS Quality component were finalized, including removal of the three points for measures that do not meet case minimum requirements and removal of bonus points for reporting additional outcome or high-priority measures. The Improvement Activities (IAs) component expanded to include seven new IAs, three of which relate to promoting health equity. Small practices (15 clinicians or less) are automatically exempt from the Promoting Interoperability component starting in 2022. Alternative Payment Models (APM) Track For the Alternative Payment Model (APM) track, CMS will sunset the CMS Web Interface as a reporting mechanism for APM entities, beginning in 2024. MIPS Value Pathways (MVPs) A new QPP pathway called MIPS Value Pathways (MVPs) was finalized to start in 2023. This pathway for MIPS clinicians includes sets of defined measures and activities related to a specialty or condition. An MVP on “Coordinating
Stroke Care to Promote Prevention and Cultivate Positive
Outcomes” will be available for reporting starting in 2023. The AAN is dedicated to providing members with tools and resources to meet reporting requirements, avoid penalties, and achieve success in the QPP. For more information and up-to-date QPP resources, visit AAN.com/QPP or email practice@aan.com. Seattle: April 2 –7 Virtual Experience: April 24–26
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Make Use of Axon Registry Cross-cutting Measures
Many neurology practices already collect cross-cutting measure data. A cross-cutting measure is a measure that is broadly applicable across multiple providers and neurology subspecialties. For example, the denominator may apply to patients diagnosed with multiple sclerosis, epilepsy, Parkinson disease, dementia, and headache or the denominator may apply to all visits for a patient seen at a neurology clinic. The Axon Registry® is available to assist in gathering data needed for cross-cutting measures, as well as diseasespecific measures. By participating in the Axon Registry, you will be able to benchmark your performance and compare how your performance to your neurology peers. The Axon Registry is a quality improvement registry for neurology that is designated by the Centers for Medicare & Medicaid Services as a Qualified Clinical Data Registry. For 2022, there are 49 Axon Registry quality measures, of which seven are cross-cutting measures. These measures can be especially helpful for neurology practices that have small patient volumes for disease-specific measures since the cross-cutting measures in the Axon Registry are applicable to broad populations of neurologic patients. Below are the seven cross-cutting measures in the Axon Registry; measure specifications can be found at AAN.com/Axon. These measures are clinically relevant, easily implemented, and are broadly applicable. Axon 17: Documentation of Current Medications in the
Medical Record
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. Axon 18: Advanced Care Plan
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record, or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan. Axon 40: Quality of Life Assessment
Percentage of patients age 18 years and older with a neurologic condition who had a PROMIS-29 administered, the results reviewed, and had appropriate follow up. Axon 52: Preventative Care and Screening: Unhealthy
Alcohol Use: Screening and Brief Counseling
Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 12 months
AND who received brief counseling if identified as an unhealthy alcohol user. Axon 54: Quality of Life for Patients with Neurologic Conditions Percentage of patients whose quality-of-life assessment results are maintained or improved during the measurement period. Axon 59: Use of High-risk Medications in the Elderly Percentage of patients 65 years of age and older who were ordered at least two of the same high-risk medications. Axon 64: Patient Reported Falls and Plan of Care Percentage of patients (or caregivers as appropriate) with an active diagnosis of a movement disorder, multiple sclerosis, a neuromuscular disorder, dementia, or stroke who reported a fall occurred and those who fell had a plan of care for falls documented at every visit. These seven cross-cutting measures can be used for internal quality improvement initiatives, continuing certification, and for MIPS submission through the Axon Registry. You may already be capturing this data for MIPS reporting and transitioning to Axon Registry would support your existing data collection needs while expanding opportunities to collect neurologyspecific data. If you are interested in joining the Axon Registry, contact registry@aan.com.
