Over past several years medical practices have found the documentation for accurately coding E/M services to be lengthy and complicated. Hence, the American Medical Association has revised E/M coding guidelines for 2021. These changes would reduce administrative burden, improve payment accuracy and make it relevant to current medical practice.
Effective Date: The changes will be applicable from Jan 1, 2021.
Key Highlights of changes:
◘ Code 99201 is deleted
◘ Code 99211 do not require time component
◘ E/M level can be selected based on MDM or Time
◘ Time ranges for each code have changed
◘ The code selection and documentation will now be dependent only on problem pertinent history and exam
◘ 99417 is used to report prolonged services (only when primary coding is based on time) in office or other outpatient services. However, CMS considered that 99417 lacked clarity in code descriptor and the potential for double counting time and created a HCPC code G2212 to report prolonged service for Medicare.
(Use G2212 to bill prolonged service for Medicare)
(Some private payers may require to use 99417 for prolonged services)
(Use 99417/G2212 in conjunction with 99205, 99215)
(Do not report 99417/G2212 in conjunction with 99354, 99355, 99358, 99359, 99415, 99416)
(Do not report 99417/G2212 for any time unit less than 15 minutes)
E/M Coding Changes Snapshot:
Recommendations to the providers:
◘ Documentation: It is very important to have a standard documentation available for the services performed. The documentation will have to be concise and appropriate to derive the exact code.
◘ Time calculation: If the coding is based on time factor all the elements in the time factor should be considered and the total time should be summed up.
◘ Precision in Medical decision making: Analyze the service provided before assigning a code based on MDM.
◘ Training: The physician and staff should attend webinars with respect to 2021 changes to understand it thoroughly.
◘ Workflow and protocol changes: The practice might require to change the workflow and protocols to align to the changes. For eg: provision to document various services provided by clinical staff.
◘ E&M calculators: Use of in-built E&M calculators will help the practice to implement this change effortlessly.
◘ Periodical Audits: In-house periodical coding audits are advised to make sure that the standard coding process is been followed.
◘ Changes in Electronic Health Record systems: Check your current EMR and make sure the required templates are available to document the MDM changes. Assign specific roles and check provision to calculate the time factor for each service.
◘ Changes in billing: Make sure to implement the updated Medicare fees schedule and new codes in the system.
◘ Analytics on reimbursement: The practice can estimate the reimbursements for 2021 based on proposed changes in reimbursements and wRVU.
AAPC Evaluation and Management changes 2021
CPT® Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99XXX) Code and Guideline Changes