These same-day E/M services will not need to be continuous. Codes 9946 will still be available for instances when it is necessary to administer prolonged clinical staff services with physician or QHP supervision. If the total clinical face-to-face time spent on a patient’s case (by a QHP or clinical staff) goes beyond the E/M time allotment, there will still be an option to layer prolonged service CPTs to the claim. Correct coding for prolonged clinical staff time Of course, the time will need to be clearly documented in the patient record if it is the sole criteria for coding. Documenting clinical information in the patient recordĪ quick comparison of physician time today for new patient visits as compared to the requirements of 2021:.Referring and communicating with other health care professionals.Ordering medications, tests or procedures.Counseling and educating the patient/family/caregiver.Obtaining and/or reviewing a separately obtained history.Preparing to see a patient (i.e., review of tests).If a separate CPT does not already exist, the following activities count for physician time during an E/M visit: It is important to remember that CPTs for things like coordination of care already exist, so if that is what a provider is doing during the extended time, he or she should code for that CPT rather than adding that time toward the E/M. E/M time will still be defined as face-to-face interactions with qualified health providers (QHPs). The standard of more than half of the encounter being used for counseling or coordination of care will no longer apply. However, starting in 2021, office and outpatient providers will have the option to use time alone as the key criteria to select the level of service. Time has always been a component of E/M coding. This blog will dig a bit deeper into the ins-and-outs of using time as the criteria. What will change is the face-to-face time requirements and the way medical decision making is assessed. There are two fundamental ways to code E/M office visits (using time or medical decision making) and that will not change. The American Medical Association (AMA) – the creator of CPT® coding – will be changing the criteria to assign E/M codes to make the process more straightforward, while also considering the natural workflows already happening in day-to-day healthcare. On the guidance repository, except to establish historical facts.If you code evaluation and management (E/M) services, you’ve probably already heard that significant changes are ahead in 2021, specifically for office visits. The Department may not cite, use, or rely on any guidance that is not posted Issued by: Centers for Medicare & Medicaid Services (CMS)ĭISCLAIMER: The contents of this database lack the force and effect of law, except asĪuthorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically There are different effective dates for the chemotherapy and nonchemotherapy drug infusions codes from the therapeutic and diagnostic injection codes. Modifier -25 must be appended to the E/M service to identify that a significant and separately identifiable E/M service (higher complexity than CPT code 99211) was performed. This transmittal will update the E/M manual section indicating Medicare will pay for a medically necessary office/outpatient visit (when it meets a higher complexity level than CPT code 99211) billed on the same day as a drug administration service as specified. In Change Request (CR) 3631, carriers were instructed not to allow payment for CPT code 99211 with or without modifier -25 if it is billed with a nonchemotherapy or chemotherapy drug infusion code or with diagnostic or therapeutic injection codes. 100-04, Chapter 12, §30.6.7, and updates the policy on billing E/M services with drug administration codes. This transmittal clarifies and corrects the definition of "new patient" and "physician" for billing evaluation and management (E/M) servicesĬurrently stated in Medicare Claims Processing, Pub. Payment for Office or Other Outpatient Evaluation and Management (E/M ) Visits (Codes 99201 - 99215)
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