Deep Diving into Billing and Coding with the Billing Boys

{"title":"Deep Diving into Billing and Coding with the Billing Boys","authors":"Christopher Jones MD MBA CPC FAAHPM,&nbsp;Phil Rodgers MD FAAHPM","doi":"10.1016/j.jpainsymman.2025.02.023","DOIUrl":null,"url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Describe time-based, complexity-based, and advance care planning billing, including when to use each in the most compliant, revenue-generating way.</div><div>2. Outline a model to utilize new Caregiver Training codes and complexity add-on codes.</div></div><div><h3>Abstract</h3><div>Palliative Care (PC) programs are growing nationally. Once niche services well under the fiscal radar, many PC programs now have 7-figure budgets and a dozen or more clinicians. As programs cost more, sponsoring institutions’ expectations for clinical revenue grow, leaving PC team members working longer hours to see more patients to help close the yawning budgetary gap. Billing rules created in 1995 were rewritten in 2023 and additional significant changes will be coming in 2024 and 2025. Two PC physicians who both represent AAHPM at the AMA's RUC and are responsible for the financial health of their teams will elevate clinicians’ knowledge of billing and clinical revenue changes. The session will open with a very brief reminder of commonly used billing codes – Evaluation and Management, Advance Care Planning, Face-to-Face and Non-Face-to-Face Prolonged Service Codes, Chronic and Complex Chronic Care Management Codes, and Principal Care Management Codes. 2023 updates of Medicare Evaluation and Management guidelines applicable across all settings will be reinforced. Possible changes to Advance Practice Provider Split Share billing and both new Caregiver Training codes and new complexity add-on codes will then be described with tips given to maximize practices’ financial health. Finally, the session will look to the future. Massive changes will occur in telehealth and likely advance care planning on January 1, 2025 as pandemic rules finally expire. Attendees will be provided with up-to-the-moment guidance on anticipated changes so that they can alter their financial projections and practice models to take advantage of these upcoming changes. PC programs’ costs have become more than an organization's financial rounding error. It is critical for all clinicians to understand billing and documentation at a deeper level and this session will help attendees to become comfortable with the many current and future changes.</div></div><div><h3>Reference</h3><div>CPT 2025 Professional Edition. American Medical Association. Chicago, IL. 2025.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Page e420"},"PeriodicalIF":3.2000,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pain and symptom management","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0885392425000831","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}