2021 Evaluation and Management Medicare Overhaul

AUGUST NEWSLETTER

There are some proposed changes coming January 1, 2021 that we all need to be aware of to be prepared. We will all need to continue to monitor new information distributed to watch for any updates from now through January 1, 2021. Some current high-level points are as follows:

  • Series of Codes affected
    • New Patient Outpatient 99201-99205
    • Established Patient Outpatient 99211-99215
  • Options to bill after January 1, 2021
    • The level of medical decision making (MDM) per each level of service
    • The total time for E/M service(s) performed on the date of service

Billing from MDM

  • Areas of documentation affected to bill based off of MDM
    • The requirement of the History bullet points per level no longer needed
    • The requirement of the Exam bullet points per level no longer needed
  • Requirements to bill based off of MDM
    • There are still 3 levels of MDM
    • 2 of the 3 areas of the below need to meet to conclude the level
      • Presenting problem/Number of Diagnosis or Management Options
      • Amount or Complexity of Data
      • Risk of Significant Complications, Morbidity, and/or Mortality
  • Presenting problem/Number of Diagnosis or Management Options

  • Amount or Complexity of Data

  • Risk of Significant Complications, Morbidity, and/or Mortality

Billing from Time

  • The total time for E/M service(s) performed on the date of service
    • Time applied is the total time spent with the patient on the date of service.
    • Includes both face-to-face and non-face-to-face time personally spent by the billing provider on the date of service.
    • Examples of time spent
      • Review of records, tests, labs, etc.
      • Ordering any required tests, labs, etc.
      • Obtaining history
      • Performing the exam
      • Documenting all pertinent information in the medical record
      • Independent interpretation of tests that are not separately billable (Independent review of x-ray for example)
      • Counseling/education the patient/caregiver
      • Care coordination (not separately billed)
    • Time frame changed per level

NOTE: Keep in mind the new proposal for 99202-99215, documentation must meet TIME or MDM for the level billed

  • wRVU’s changed

AND NOW FOR…

Hospital Visit Takeaway Tips

  • Observation Billing
    • Billing Observation services can be confusing for a few reasons:
      • The patients physical location does not require the patient to be physically in the Observation area of the Hospital. It solely depends on the patients status
      • Only the admitting provider bills the Observation series of CPT codes. Any other provider that sees the patient bills the appropriate outpatient series CPT codes
  • CPT series for Observation services:
    • Observation Admitting Provider can bill:
      • Initial Observation services (99218-99220)
      • Subsequent Observation services (99224-99226)
    • All other providers can bill:
      • New patient services (99202-99205)
      • Established patient services (99212-99215)

 

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