Five Changes in CPT® Coding To Know Before 2021

Busy physicians like you have long been asking CMS to revise and simplify its laborious E/M documentation requirements.

On January 1, 2021, changes in CPT® coding will take effect that grant those requests.

The changes don’t include the radical overhaul of documenting and reimbursing office and outpatient visits CMS proposed in 2018. But they should dramatically reduce the time doctors spend doing paperwork (physical or digital). Physicians seeing 20 patients a day, for example, should have about 42 minutes more a day for patient care, according to an AAPC report of an AMA study. And the changes should also help you more quickly determine the most appropriate code for your documented work.

Giving physicians the knowledge and tools they need to properly document and claim the optimal code for their labor is our mission at MDCodePro. We’ve prepared this brief overview of the changes coming in 2021 so you’ll know what to expect and how to maximize their potential to strengthen your practice and grow your revenue.

How the CPT® Changes Aim for Quicker, Clearer Medical Coding

Here’s a look at what the CPT® coding changes in 2021 will do:

1. Provide New Choice in Determining Overall Level of Service

Currently, you must determine what CPT® code captures the overall level of service you’ve provided in an office or other outpatient visit by considering the visit’s three key components:

  • History
  • Exam
  • Medical decision-making (MDM)

For established patient visits, the code you assign must match the complexity of two of these three elements. For new patient visits, it must match the complexity of all three.

Once the 2021 changes take effect, CPT® coding of all visits covered by codes 99202-99215—in other words, new or established office visits—will be determined by your choice of either the level of your MDM or the total time (direct and indirect) spent providing service the day of the visit.

You’ll still take histories and perform exams, or review them, to establish medical necessity. But you’ll have more discretion regarding their extent . And being free to use either MDM or date-of-service time as your key to code selection should clarify your path to the reimbursement your work is worth.

2. Clarify the Nature of Medical Decision-Making 

Because you’ll be able to select codes solely on the basis of MDM, it’s more important than ever you document the correct MDM level. 

A revised Level of Medical Decision-Making table will help. It lays out the relationship between CPT® codes, the four MDM levels—straightforward, low, moderate, and high—and MDM’s three elements:

  • The number and complexity of problems you address
  • The amount and/or complexity of data you review and analyze
  • The risk of complications and/or morbidity or mortality of patient management

The revised table is simpler than the present MDM table and builds on the 1995 and 1997 E/M guidelines’ Table of Risk. It will help you confirm at a glance that you’re choosing the CPT® code that most accurately reflects the amount of cognitive labor you must do to properly treat your patient.

The 2021 guidelines also clarify and expand definitions of 22 key MDM terms and concepts. For instance: 

  • What, exactly, qualifies as “addressing” a problem?
  • When should physicians categorize an illness as “stable”?
  • Who counts as an “appropriate source” for discussing patient management, and who doesn’t?

The new regulations spell out answers to these questions and many more. You’ll have greater confidence you’re correctly representing your MDM in reimbursement claims.

3. Redefine Time Spent Providing Services

When you choose CPT® codes based on the factor of time, remember: As of January 1, 2021, “time” no longer refers to typical time spent face-to-face with patients and families, as it does now, but to minimum time spent on the date of service on all tasks related to patient care.

Right now, time can only control your outpatient visit coding when you spend more than 50% of a visit directly counseling patients or their families. Time spent reviewing data, consulting with other healthcare professionals, or even talking with the patient on the phone doesn’t count.

In contrast, the new option of using date-of-service time recognizes how much real work physicians must do for the patient outside the visit itself. “The use of date-of-service time builds on the movement over the last several years by Medicare to better recognize the work involved in non-face-to-face services like care coordination,” states the AMA.

Other activities that will count toward minimum date-of-service time include:

  • Obtaining and/or reviewing a separately obtained history
  • Ordering medications, tests, or procedures
  • Documenting clinical information in an EHR or other health record
  • Independently interpreting results (not separately reported) and communicating results to patients or their families and caregivers

A shorter prolonged services code, to be reported only with codes 99205 and 99215, will capture time in 15-minute increments.

You’ll need to keep a close eye on the clock when choosing to document based on time. But because the new guidelines encompass direct and indirect care, you should be able to meet the minimum time threshold for higher value CPT® codes when warranted because you’ve appropriately documented all you’ve done.

4. Reorganize the CPT® Coding Manual

To underscore the fact that the 2021 CPT® coding changes apply only to office or other outpatient visits, CPT® will publish them under their own separate section header. 

5. Eliminate Code 99201

You haven’t been using it, have you? Neither have your colleagues.

Since both codes 99201 and 99202 involve straightforward MDM and differ only in history and exam elements, 99201 (level 1 new patient office/outpatient E/M visit) will be deleted—the victim of what Becker’s ASC Review calls “low utilization.”

Let MDCodePro Help You Master Your E/M Documentation

Smiling male doctor wearing lab coat and stethoscope sits at glass table in office, typing on desktop computer’s keyboard. Despite the CPT® coding changes due in 2021, one thing won’t change: Your need to accurately and comprehensively document your work.

Thanks to the new guidelines, E/M documentation should be less burdensome, but it will be no less important for determining how much reimbursement you receive for the services you provide.

If you’re looking for a convenient way to bolster your knowledge of E/M coding and an intuitive tool you can use to consistently select the optimal code for each patient visit, contact MDCodePro today. Throughout 2020, we will be updating specific content to address the coming changes so that you are fully prepared to accurately code your office visits starting January 1, 2021.

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