By:Jacqueline Thelian, CPC, CPC-I, CHCA, CPMA
2021 E/M Outpatient Documentation & Coding Changes
- Key Changes to Definitions & Concepts
- Elimination of History & Physical Elements for Level of Code selection
- Code selection Based on Medical Decision Making (MDM) or Time
- Criteria changes to determining the Level of Medical Decision Making (MDM)
- Criteria changes to determining the Level of service based on Time
By:Jacqueline Thelian, CPC, CPC-I, CHCA, CPMA
In this video we will go over:
- ICD-10-CM overview of Updates
- Most Notable Updates
- Chapter 22 – Codes for Special Purposes – New Chapter!
- Where you can go to learn more
By:Jacqueline Thelian, CPC, CPC-I, CHCA, CPMA
Effective April 1, 2020 there are two new HCPCS codes for COVID-19 Laboratory testing.
U0001 CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel
For tests developed only by the CDC (reporting allows CDC testing laboratories to test new patients and track new cases).
U0002 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC
For laboratories performing non-CDC testing.
As a reminder the CPT code for COVID-19 Laboratory which is effective as of March 13, 2020 is:
87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique
As always different insurers may require reporting either a CPT® or a HCPCS code, so please check with your payers as to their preference.
The ICD-10-CM code for COVID-19 effective April 1, 2020:
U07.1 COVID-19
By:Jacqueline Thelian, CPC, CPC-I, CHCA, CPMA
As per CMS (Centers for Medicare and Medicaid Services) the answer is yes!
CMS has approved on a temporary basis during the COVID-19 Pandemic the following CPT Codes:
97110 Therapeutic exercises
97112 Neuromusulcar reeducation
97116 Gait training therapy
97161 PT Eval low complexity 20 min
97162 PT Eval mod complexity 30 min
97163 PT Eval high complexity 45 min
97164 PT re-eval established plan care
97165 OT eval low complexity 30 min
97166 OT eval mod complexity 45 min
97167 OT eval high complexity 60 min
97168 OT re-eval established plan care
97535 Self-care management training
97750 Physical Performance Test
97755 Assistive Technology Assess
97760 Orthotic management & training initial encounter
97761 Prosthetic training 1st enc
It is important to note the following when reporting these services via telehealth:
The telehealth waiver for Medicare, authorized under HR 6074 (attached), removes the requirement that telehealth services be rendered from an “eligible originating site” and relaxes certain technology requirements, permitting services via Skype and FaceTime with a cell phone.
This allows telehealth services to be provided in all settings, including at a patient’s home, for the duration of the COVID-19 emergency. Importantly, there is no requirement that the services provided under the waiver be related to treatment of COVID-19. The waiver is designed to assist providers with social distancing protocols and to allow patients to continue to seek treatment of chronic and acute conditions during the pandemic.
To the extent the waiver (section 1135(g)(3)) requires that the patient have a prior established relationship with a particular practitioner, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during the COVID-19 emergency.
In addition, the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype.
Remember to report Place of service Code 02 Telehealth on telehealth services.
Medicare does not require the use of modifier 95 Synchronous Telemedicine Service Rendered Via a Real Time Interactive Audio and Video Telecommunication
Source:
For a full list of CMS Telehealth Approved CPT codes:
https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes
By:Jacqueline Thelian, CPC, CPC-I, CHCA, CPMA
What you need to know During this unprecedented healthcare crisis with the COVID-19 pandemic, healthcare services are rapidly changing to make expanded access to Telehealth services to allow patients the opportunity to receive services from their doctors without having to travel to a healthcare facility and risk potential exposure to the virus.
As a service to our clients and the healthcare providers courageously serving the population, I have created a video detailing what you need to know to provide Telehealth, telephone and remote services to your patients.
The video will also provide you the links to the source documents from CMS and NYS Medicaid and show you where to go to sign up for updates.
I hope this information helps clear up any confusion you may have regarding remote office visits and services. And if you have any addition questions, we are here to help.
Thank you and be safe,
- Jacqueline Thelian
Video Links:
The latest NYS specific information can be found on the NYSDOH website at the following link:
https://www.health.ny.gov/diseases/communicable/coronavirus/
The latest Centers for Disease Control and Prevention (CDC) guidance for healthcare professionals is available at the following link:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html
More information on the current telehealth policy can be found in the February 2019 Medicaid Update at the following link:
https://www.health.ny.gov/health_care/medicaid/program/update/2019/2019-02_speced.htm
Additional guidance can be found on the filling CDC websites:
When services are provided by an Article 28 facility, the telehealth practitioner must be credentialed and privileged at both the originating and distant sites in accordance with Section 2805-u of PHL. The law can be viewed at the following link:
http://public.leginfo.state.ny.us/lawssrch.cgi?NVLWO
MMC general coverage questions may be directed to the Division of Healthcare Planning Contracting and Oversight (DHPCO) at covques@health.nt.gov
Fact Sheet visit: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
Frequently Asked Questions visit: https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf
CMS Coronavirus Partner Virtual Toolkit https://www.cms.gov/outreach-education/partner-resources/coronavirus-covid-19-partner-toolkit
Sign up for CMS Updates https://public.govdelivery.com/accounts/USCMS/subscriber/new?preferences=true#tab1
Telehealth Benefits in Medicare are a Lifeline for Patients During Coronavirus Outbreak
Coverage and Payment Related to COVID-19 Medicare
https://www.cms.gov/files/document/03052020-medicare-covid-19-fact-sheet.pdf
List of Medicare Telehealth Services
https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes
By:Jacqueline Thelian, CPC, CPC-I, CHCA
Significant changes to the E/M Documentation Guidelines for “outpatient visits” will an important change in 2021.
CMS, the AMA and most physicians agree the cognitive work of physicians and qualified healthcare professionals for E/M office visits is best determined by the time and the level of medical decision making. Therefore, the proposed guidelines for 2021 allow the physician/QHP to select the level of service based upon time or the level of medical decision making.
The AMA has updated the Table of Risk (download below) to include clearer definitions relating to the Number and Complexity of Problems Addressed, the inclusion of Categories regarding Options for the Amount and/or Complexity of Data to be Reviewed and Analyzed as well as straightforward definitions of Risk on the Risk of Complications and/or Morbidity or Mortality of Patient Management.
2021 will also include the deletion of CPT code 99201 Outpatient Office Visit for a New Patient at the lowest level, and a new HCPCS Level II code GPC1X Visit complexity inherit to evaluation and management associated with primary medical care would be added to established office/outpatient CPT® codes. This new add on code will reimburse $15.00.
By:Jacqueline Thelian, CPC, CPC-I, CHCA
Whether you are a Diagnostic Testing Facility, an Independent Laboratory or a Physician who received referrals, you need to make sure your orders are valid and validated.
Valid orders include at minimum, the patient’s name, test(s) ordered, indication for the test(s), a clear and legible name of the ordering physician, the ordering physician’s signature and date of the signature. Remember signature stamps are not valid.
However, on many occasions the order is incomplete and/or illegible.
CMS as well as many other insurers are now asking the “rendering” provider to validate the order.
As per CMS, “The physician who treats a beneficiary must order all diagnostic x‐ray tests, diagnostic
laboratory tests, and other diagnostic tests for a specific medical problem. Documentation in the patient’s medical record must support the medical necessity for ordering the service(s)”
CMS goes on to say, “However, it remains the responsibility of the individual or entity upon whom/which the request has been made to provide documentation.”
Therefore, in order to validate the request for the test, it is the responsibility of the rendering/servicing provider to produce the patient’s medical progress note from the ordering physician which documents the test(s) ordered as well and the medical necessity and indication for the test.
By:Jacqueline Thelian, CPC, CPC-I, CHCA
2020 CPT includes 384 changes, including 248 new codes, 71 deletions and 75 revisions. Are you ready?
E/M codes for online digital E/M services.
99421 – On-line digital E/M service for an established patient for up to 7 days, cumulative time during the 7 days; 5-10 minutes, 99422 11-20 minutes and 99423 21 or more minutes.
These services are reported through HIPAA Compliant secure platforms, such as an electronic health record portal, secure email, and other secure digital applications.
Time reported is cumulative during a seven-day period and physicians and QHPs in the same group practice contribute to the total service time.
Dry Needling
These long-awaited CPT codes are finally here. 20560 Needle insertion(s) without injection(s) 1 or 2 muscle(s) and 20561 for 3 or more muscle(s).
Long Term EEG Setup & Monitoring
This section underwent a complete overhaul.
Codes 95950, 95951, 95953, 95956 are being deleted.
23 codes (95700 – 95705-95726) are being established to replace the deleted codes - 13 Technical Component only
For a comprehensive listing and review of all the new and revised CPT codes come and join us at the 2020 CPT Workshop offered for the first time in New York. The course includes the 2020 CPT Manual (Professional Edition) and its companion CPT Changes An Insiders View.
