The American Medical Association (AMA) implemented major changes to the 2021 Current Procedural Terminology (CPT) code set in an effort to streamline coding and documentation of office visits and other outpatient evaluation and management (E/M) services.
Streamline E/M Coding
These new modifications were designed to make E/M office visit and documentation simpler and more flexible. This will free physicians and care teams from clinically irrelevant administrative burden that led to time waste.
The code set released in the start of September 2020, modified E/M office visit codes 99201 through 99215 will enable physicians to select the code levels based on medical decision-making or total time. These new updates are proposed for adoption by the Centers for Medicare and Medicaid Services on Jan. 1, 2021.
The E/M office visit modifications include:
- Eliminating history and physical exam as elements for code selection.
- Allowing physicians to choose the best patient care by permitting code level selection based on medical decision-making (MDM) or total time.
- Promoting payer consistency with more detail added to CPT code descriptors and guidelines.
“To get the full benefit of the burden relief from the E/M office visit changes, health care organizations need to understand and be ready to use the revised CPT codes and guidelines by Jan. 1, 2021.
The AMA is helping physicians and health care organizations prepare now for the transition and offers authoritative resources to anticipate the operational, infrastructural and administrative workflow adjustments that will result from the pending transition,” said AMA President Susan R. Bailey, M.D.
The AMA labeled these new changes to the CPT codes as the “first major overhaul in more than 25 years to the codes and guidelines for office and other outpatient evaluation and management (E/M) services.”
E/M coding requirements have contributed to clinician burnout for decades, according to CMS.
New CPT Codes and Pandemic
Since the start of the pandemic earlier this year, the AMA has approved and immediately implemented a lot of new CPT codes to permit for the documentation of COVID-19 testing, including five Proprietary Laboratory Analyses (PLA) codes.
EHR System Updates
Providers have to manually upload the coder descriptors of the COVID-19 pandemic test codes into their EHR systems, according to the standard release delivery process for the CPT codes. The new codes are now part of the complete CPT set in the data file for 2021.
Industry groups have said the new codes and guidelines will “streamline documentation requirements” and “contribute to a better environment for healthcare professionals and their Medicare requirements. Also, among this year’s important changes to the CPT code set are new medical testing services developed during the COVID-19 pandemic, including diagnostic and antibody tests for the novel coronavirus.
Technological advances in the field of continuous cardiac monitoring and detection have prompted the addition of codes 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248, along with associated guideline revisions. These codes will replace Category III codes 0295T, 0296T, 0297T, and 0298T, which were deleted.
These new codes utilize an innovative algorithmic technology that works in concert with a patch that is much easier to wear for patients and provides more accurate and complete data for physician interpretation.
Overall, the 2021 CPT code set has 328 editorial changes, including 206 new codes, 54 deletions, and 69 revisions. The majority of new codes in 2021 (63 percent) are involved in new technology services described in Category III CPT codes and the continued expansion of the PLA section of the CPT code set, AMA reported.
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