This year we have some rather important changes to be aware of. For some of you this will affect reimbursements and for all of you it will affect documentation. See below for the major changes:
Elimination of the History (H) and Physical Exam (PE) as elements (providers should perform a “medically appropriate history and/or examination” there will be NO required level of history or exam for 99202-99215.
Clinicians can now choose whether MDM or Time documentation can determine the appropriate E/M Code
MDM Modification 3 MDM subcomponents remain the same but there are extensive edits to elements for code selection.
Deletion of CPT Code 99201
Shorter Prolonged Service Codes, the definition of time is minimum time, not typical time and represents total physician/QHP time on the date of service (see below for what is included in time)
The care team may collect information and the patient or caregiver may supply information directly (by portal or questionnaire) that is reviewed by the reporting physician or other QHP
Physician or other QHP includes, preparing to see the patient including review of tests, obtaining/reviewing separately obtained history, performing medically appropriate exam/eval, counseling/education to patient/family/caregiver, ordering meds, tests, or procedures, referring and communicating with other health care professionals, documenting clinical info in EMR or other Health record, independent interpretation of results and communication of results to patient/family/caregiver, and care coordination.
Some new/revised key codes to add to your EMR and be aware of how to use them:
99415 Prolonged Clinical Staff Service direct patient contact with physician supervision. First Hour, note it doesn’t have to be continuous
99416 Prolonged Clinical Staff Service direct patient contact with physician supervision. Each Addl 30 minutes, it doesn’t have to be continuous
99417 Prolonged OV E/M service total time with or without direct patient contact each 15 minutes to be used ONLY with 99215 or 99205
99358 Prolonged Services Code w/o Direct Contact first hour regardless of POS
99359 Prolonged Services code w/o Direct contact first hour regardless of POS addl 30 mins
99354-99357 Prolonged Service Codes with Direct contact for physician or other QHP for Inpatient or Observation setting beyond the usual time.
We understand this may appear confusing; however, it’s extremely important that you understand how to use these codes in your practice; your revenue depends on it.
The most important thing to understand is documenting all of the pertinent medical information but now it’s also important to document start and stop times, time used consulting, time spent on the phone with family, caregivers and patients, time spend reviewing records etc.
You know the old saying “time is money”, well in this case it really is, so we are asking that you be mindful in your code selections. You will be using a combination of codes you may not have used before and you will need to document why.
Sit down with your staff and office manager and determine how this can be done if you haven’t done so already. For those of you who are clients feel free to reach out to us if you have any questions. As always we will be looking at your notes to insure that times are documented and code selection is correct based on the notes.
Have a Safe and Healthy 2021! Wishing you the best, Linda