December 11, 2020 | By Pam Vanderbilt, CPC, CPMA, CPPM, CPC-I, CEMC, CEMA, CEMA-O
There is a long-standing rule in our family that Christmas is not allowed to start until the Thanksgiving dinner dishes are washed and put away. I must be completely honest; that family rule has been thrown out the window this year. Our tree is up, the radios have been tuned to 24/7 Christmas music stations for several weeks, AND… one of my favorites treats of the season, Hallmark Christmas movies, are already playing 24 hours a day. Today’s tip was written on Thanksgiving morning with the Macy’s parade in the background. This year has been anything other than normal, and my family was more than ready for the comfort that our Christmas traditions bring.
A lot of what we consider “normal” at this time of year is not happening. For the first time, many of us will be having Thanksgiving by real-time audio/video connection (is there a code for that?). Our traditional college football rivalry games won’t be played on the Saturday after Thanksgiving (GO Gators!). Something that has been trending “normal” for a while, we are likely to do even more of our shopping for gifts this year online (support your small businesses).
However, some of our professional traditions will continue despite the pandemic. ICD-10 changes were released earlier in the fall and we are knee-deep in reviewing the recently released Medicare fee schedule the final rule. We can also count on CPT changes going into effect after the fireworks go off at midnight on December 31st.
In addition to the “normal” changes to CPT, this year brings the biggest changes to E&M since the 1995 and 1997 documentation guidelines were published. NAMAS, AMA and other respected organizations have spent much of this year getting the word out about these changes and how they effect provider documentation, coding and auditing.
There is a lot of information in the new guidelines that helps clear up gray areas we have often had differing opinions on, e.g., what is additional workup or drug therapy requiring intensive monitoring for toxicity. However, the changes are new to all of us and in some ways, quite foreign to our way of thinking.
One such example is the use of time when determining the level of service. According to the E/M Office Visit Compendium 2021, published by the AMA, “Prior to the implementation of the 2021 CPT coding guidelines, the use of time as the determining factor to qualify for a particular level of E/M office or other outpatient service was permitted only when counseling and/or coordination of care dominated (i.e., took up >50% of the encounter). In addition, only face-to-face time could be included in the time calculation.”
Beginning in 2021, time can be reported for office visits whether or not counseling and coordination of care dominate the visit. It also includes the total time spent by the provider on the day of the encounter, not just face-to-face time. This means we can truly use time for any office visit service.
The choice to use MDM or time will be driven by the presenting problems of the patient and the time and complexity of the visit. Some visits may be higher complexity but take a shorter amount of time. MDM would likely be the choice for code selection for these visits. On the other hand, some visits are truly more time-intensive even if the presenting problem ends up being lower risk, so the level of service would be based on total time.
It will take some practice to completely wrap our minds around this change. As you are auditing 2021 E/M encounters that include time, take a minute to consider if the new definition of time for office visits would have been beneficial in the code selection.
If you have been joining NAMAS for the “2021 E&M Changes” series of webinars, you know we have broken down the information into bite-sized pieces to help you prepare yourselves and your providers for this shift. If you missed any of the series of webinars, they are available on-demand at https://namas.co/em-webinar-series/
The final presentation in this special series is a hands-on/questions and answers webinar on December 14. If you are joining us live, we need your involvement. We will put our brains together and work thru some case examples, so be prepared to share how you would apply the new AMA CPT guidelines to the examples with the rest of us. If you have been practicing (we hope you have) bring any questions about the new guidance you have so we can discuss.
Until we are all able to be together in person again, enjoy safe and joyful modified holiday traditions!