We want to thank all of our clients and business associates for your continued support, generosity, and trust in our company. Thank you for allowing us to serve you this most challenging year and we look forward to serving you in the years to come.
Despite the ups and downs of 2020, we all have pulled together, and gotten through it. We move into 2021 with great aspirations and hopes for all of us. We look forward to our continued relationships and wish you and your families a Very Happy New Year with good health, & much success and happiness.
Happy New Year, Your partners and friends at Advantage Medical Billing Solutions!
Linda J Sacco, Founder & CEO
CARES (The Coronavirus Aid, Relief, and Economic Security) (CARES) Act suspended the payment adjustment percentage of 2% applied to all Medicare Fee-For-Service (FFS) claims from May 1 through December 31. The Consolidated Appropriations Act, 2021, signed into law on December 27, extends the suspension period to March 31, 2021.
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
Many providers are not familiar with these codes and are missing out on the
reimbursement for these services. Let me explain services provided in order
to bill for these codes. The provider discusses and shares planning for the
future health care needs of the patient including Advance Directives. Examples
of written Advance Directives would include but not limited to are Health Care
Proxy, Durable Power of Attorney for Health Care, Living Will, or Medical Orders
for Life-Sustaining Treatment (MOLST). This discussion is typically 30 minutes
with the patient, his family, or someone representing the patient. Advanced care
planning focuses on the patient and involves both the patient and the provider
responsible for their care. It empowers the patient to make an informative decision
about their future care including their advanced care decisions. This gives
the patient the opportunity to express their preference for care depending on their
current and future health status and treatment options available. The provider may
enter the actual plan on forms specifically designed for that purpose in the
There are two CPT codes for Advanced Care Planning, 99497 which are used for up
to a 30 minute discussion, and 99498 which is an add on code for each additional
30 minutes of the discussion. These codes can be billed at the same time as other
medical services taking place at the same visit before or after the time spent
on advanced care planning. Don’t forget to add a 25 modifier to the office visit
code. The 2017 Medicare allowed reimbursement amounts are 99497 $88.15
and 99498 $76.60.
I am certain many of you have provided these services to your patients and just
bundled it into the office visit code and losing out on and additional
$88-$164.00 per encounter. Add these codes to your superbill and your EMR
templates so they are not forgotten!
As always, Take Advantage for all of your outsourced medical billing needs!