PCM Presurgical Optimization Coding Primer and References
AAHKS has worked with CMS and the AMA RUC for years to recognize the pre-optimization work and practice changes physicians undertake for better patient care. Late in 2022, the AMA CPT Assistant provided details on how arthroplasty surgeons may use principal care management codes for this work, including that “the principal care management (PCM) codes (99424-99427) are appropriate for reporting preprocedural optimization management services.”
PCM Primer and Webinar
The AAHKS Advocacy Committee and Health Policy Fellows have developed a primer to help members navigate utilizing the Principal Care Management codes CMS has approved for use in capturing the pre-optimization work you may be doing to take care of your patients. As previously reported, late in 2022, following AAHKS’s work with CMS and the RUC to determine how to capture and pay for this work, the AMA CPT Assistant provided details on how arthroplasty surgeons may use principal care management codes. This primer provides details on what needs to be collected and how best to record the work you and your team are doing.
- AAHKS PCM Primer for Capturing Pre-Optimization Care in TJA
- AAHKS Webinar Recording: Getting Reimbursed for TJA Pre-Optimization Work with Principal Care Management Code
A subscription to AMA CPT Assistant is required to look up the codes or view the article (page 16 of the Nov. 2022 print version), which includes examples of use developed by AAHKS and AAOS leaders. While these codes are now available for use, in order to properly code them, please utilize the resources below.
- CMS MLN Booklet for PCM Coding
- AAOS Webinar on Preprocedural Optimization Services
- AAOSNow Pre-Optimization Coding Article
- Presurgical Optimization Quick Reference Guide
Mandatory CMS Inpatient TJA PRO-PM
The Centers for Medicare & Medicaid will be implementing a mandatory inpatient PROM for THA and TKA next year. The goal of this measure is to quantify pain and functional improvements with validated patient-reported outcome measures (PROMs) to improve patient lives. The Inpatient Quality Reporting Total Hip and Knee Replacement PROMs Performance Measure (IQR THA/TKAPRO-PM) can be submitted to CMS via AJRR and contains 3 new data elements, including Medicare beneficiary ID, narcotics used ≥90 days and the person completing assessment. For the 2027 payment year, the performance period begins July 1, 2024 and the pre-op data collection window begins April 2, 2024. Listen to our Amplified Podcast on the topic and click to read the AJRR FAQs for more details.