New Principal Illness Navigation Codes and More as 2024 Gets Underway

Prepare for new HCPCS, CPT codes effective Jan. 1 

By Brian Murphy

2024 is here and new codes are in effect. Both CPT and HCPCS.

My old friends at ACDIS reminded me as much. Take a look at the list of new HCPCS codes in the article below. One group of new codes jumped off the page: Principal Illness Navigation (PIN).

It’s amazing it took this long to get these, but it’s also a wonderful move by CMS. We (and by we, I also mean, me) often criticize CMS. But to me this is a praiseworthy development. Healthcare is confusing and fragmented. For everyone, but especially he patient. The more we help patients understand their treatments and navigate the many steps required to see them through something like a long course of cancer treatment, the better. For the sake of patient experience but also treatment efficacy.

But providers need incentives. If you’re not going to pay them to coordinate care, and they’re already working under a crushing workload and after-hours documentation and billing, they won’t.

These four new HCPCS codes offer that incentive.

Of course implementation won’t be a snap. As described by the highly recommended article below by CodingIntel, you read to read the fine print. Here’s a summary:

The codes are G0023, G0024, G0140, G0146

• G0023: Principal illness navigation services by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a patient navigator; 60 minutes per calendar month (see full code description at link below for list of approved services)
• G0024: Principal illness navigation services, additional 30 minutes per calendar month (list separately in addition to G0023)
• G0140: Principal illness navigation – peer support by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a certified peer specialist; 60 minutes per calendar month (see full code description at link below for list of approved services)
• G0146: Principal illness navigation – peer support, additional 30 minutes per calendar month (list separately in addition to G0140)

The services are:

• Described in the 2024 Physician Fee Schedule Final Rule.
• Incident-to; incident-to warrants its own blog post but in short are billed as part of the physician’s services, in his or her office setting and under supervision
• Require have an initiating E/M visit before you can bill these codes
• Require informed consent from the patient
• Time-based
• G0023 and G0024 are for certified or trained auxiliary personnel, while G0140 and G0146 are for “peer support” by certified or trained auxiliary personnel for patients with behavioral health conditions.
• Certified or trained auxiliary personnel can be employees or under contract with a medical practice, with a strong emphasis on clinical integration and engaged in regular communication with the billing practitioner.
• CMS does not restrict PIN services to once per beneficiary/month, but a single physician cannot bill for PIN services twice in a month.
• If a patient has more than one principal condition, two PIN services could be reported by different practitioners, although CMS has concerns about duplication and fragmentation.

In short, these codes require strong coordination among the provider team and (no surprise) adequate supporting documentation. I doubt these services could be outsourced to a third-party vendor who just drops patient instructions in an app and then bill CMS for it.

CMS in the 2024 PFS final rule has already expressed concern about potential misuse so I would expect we’ll see compliance audits.

Anyway, check out the CodingIntel piece for more information and the ACDIS piece for a fuller list of all new HCPCS codes.

You’ve got a couple weeks before they take effect. If you get a few minutes before the holiday break, review them and notify your providers.

References

ACDIS, First quarter 2024 HCPCS Level II code update brings more than 300 new codes: https://acdis.org/articles/news-first-quarter-2024-hcpcs-level-ii-code-update-brings-more-300-new-codes

CMS, HCPCS Quarterly Update: https://www.cms.gov/medicare/coding-billing/healthcare-common-procedure-system/quarterly-update

CodingIntel, CMS finalizing Principal Illness Navigation (PIN) services: https://codingintel.com/principal-illness-navigation-pin-services/