The ACA’s Health Policy and Advocacy Committee (HPAC) recently posted several coding guidance documents on the ACA website to educate members about updates to select procedure and therapy codes. The ACA Blog reached out to T. Matthew Christopher, DC, MBA, CPC, CPMA, CPCO, CPB, CCPC, a member of HPAC’s Code Utilization and Application Subcommittee, to learn more about the updates and their significance. For additional information, visit ACA’s website for Coding Guidance and Coding Alerts.
Editor’s Note: Dr. Christopher, along with subcommittee members Drs. Cynthia Chapman, Michael Massey, and Leo Bronston, will host an online discussion on Nov. 14 at 8 p.m. ET to review the latest coding updates. Register for the event here.
Tell us about your participation in the Health Policy & Advocacy Committee and Code Utilization and Application Subcommittee. How does the work of these groups impact ACA members?
Dr. Christopher: The committee is a group of volunteers who work to identify trends in healthcare policy, especially those related to provider parity, fairness and inclusion. Based on these trends, we recommend policy priorities to the Board of Governors and create ACA member training and resources.
The Code Utilization and Application Subcommittee is a subgroup of the ACA Health Policy & Advocacy Committee that focuses on clinical coding topics. Our team creates free webinars for ACA members and provides guidance related to procedure and diagnosis coding.
Subcommittee members also work with the ACA to advocate for our members when needed. For example, subcommittee members recently assisted ACA leadership in addressing inaccurate guidance published in a well-known medical coding reference last month.
A subcommittee member recognized that this incorrect guidance could adversely impact ACA members, non-member chiropractors, and other physical medicine provider specialties. Thanks to our subcommittee’s efforts, ACA leadership reached out to non-chiropractic professional associations whose members were also adversely impacted by this inaccurate statement. This collaboration resulted in a joint letter to the publisher requesting a correction of the article that contained incorrect physical medicine coding guidance.
Is the latest coding guidance new, or just an update to previously posted coding documents?
Dr. Christopher: The latest ACA coding guidance contains both new and updated documents. We are revising previous documents so that they continue to reflect current coding best practices. We also incorporate a consistent structure across all documents and provide more links and references to additional external coding resources.
In addition to these updates to previous documents, we are also creating several new guidance documents. New coding guidance documents will soon address procedure codes for chiropractic manipulative treatment (CMT), consultations, and prolonged evaluation and management (E/M) services.
Will the updates mean major changes for doctors in comparison with how they are coding now?
Dr. Christopher: The impact of the changes to the previous coding documents will vary from one practice to another. Since some of the new information addresses recent provider questions, those updates will likely be helpful for many practices. However, most previous recommendations are relatively unchanged unless we needed to modify the content to reflect updated coding rules. Many of the changes to previous recommendations were related to recent revisions to E/M codes.
Several articles that previously addressed very focused topics now also contain additional general information about the code(s). The additional high-level coding information in the updated guidance might especially benefit recent graduates or other providers learning about the code(s) for the first time.
What do doctors need to pay special attention to as they review and begin to implement this guidance?
Dr. Christopher: Following an introduction to the topic, each document contains a definitions section to provide background information. Once doctors become familiar with these initial sections, they should primarily focus on the application section. This section may address different scenarios for which doctors must select a code. For example, the TENS coding guidance addresses coding concepts related to TENS treatment applied in the office, TENS units dispensed as durable medical equipment for use outside the office, and TENS training and instruction performed in the office. In other documents, the application section provides information about bundling rules that apply when multiple procedures are performed on the same date.
Also, the guidance documents reference other resources with additional information on the topic. Links are often provided to additional ACA coding guidance on the website that touches on similar topics that may interest doctors. For example, the Acupuncture Services coding guidance links to a related ACA coding guidance on dry needling. Additionally, many documents include a substantially more extensive “References” section so that members know where to access the source information we used to create the guidance.
Lastly, providers should consider that the new guidance only reflects generally accepted coding practices. However, some nuances may change from one third-party payer or jurisdiction to another. While the new documents are products of extensive research and are well-referenced, we also encourage providers to consider any other rules specific to the relevant jurisdiction or third-party payer. State chiropractic associations may also be able to provide state-specific information or guidance related to a particular carrier.
Is there anything else you would like us to know about the new coding documents?
Dr. Christopher: Since the codes change regularly, these are “living” documents. Many new and revised documents are already in the pipeline for future release. Members can remain up to date by using current, official coding references in day-to-day practice and checking the ACA guidance periodically for updates.
It is also important for providers to realize that these updates result from a highly collaborative approach to ensure that the documents are current, accurate and complete at the time of publication. In addition to the hours of work invested by our subcommittee members, we request feedback and guidance from other clinical, legal, and coding experts when appropriate.
If an ACA member has questions about the new coding documents, is there someone they can contact?
Dr. Christopher: We welcome questions and comments related to these documents. Doctors can contact ACA’s Education and Health Policy Team at [email protected]. They will forward the questions to the appropriate volunteer subject matter experts. In addition to providing a reply, we can consider updates to future coding guidance documents based on the questions and comments we receive. We also welcome suggestions for future coding guidance topics.
