Prepare Now for 2021 Outpatient E/M Coding Changes Beginning January 1, 2021, the way neurologists will document and submit claims for outpatient E/M services will change. The key changes are that the history and physical exam components will no longer be used in code selection while medical decision-making becomes the key non-time component, or the total time devoted to patient care on the date of service will be used for code selection. Also, additional time units of 15 minutes can be used for prolonged service and the new patient code 99201 will be eliminated. While these changes are still months away, there are important considerations that should be reviewed now in order to prepare. The nuances of the changes to the documentation guidelines for outpatient E/M services will be covered in future AAN resources, but in the interim it is important to first examine the way your practice currently uses the codes for office visit E/M services to fully understand how the changes will impact you.
Is your code choice for 99211–99215 Cohen codes heavily weighted to elements of history and physical examination and if so, how detailed are your charts as they related to medical decision-making?
Said Bruce H. Cohen, MD, FAAN, who serves as CPT adviser on the Coding and Payment Policy Subcommittee and is a member of the Health Policy Subcommittee, “This is a once in career opportunity for neurologists to alter the manner they document patient care, as these changes allow us to eliminate the duplicative or irrelevant documentation and focus on the issues, and be acknowledged for the time, that affects patient care. However, we will need to focus on our written communication skills as they relate to medical decision-making documentation, but in the end, everyone will benefit from these changes.”
Or does your practice select the appropriate code based on time? (Current rules state that in order to bill an E/M visit based strictly on time, at least 50 percent of the encounter must be dedicated to counseling and coordination of care.)
A few questions to ask when examining your current practice or workflow are: What are your current billing patterns in terms of level of the encounter? What is the breakdown of each level of service billed by your practice? Does your practice select the appropriate code based on bullets or typical time/counseling and coordination of care to achieve each level?
How comfortable are you with the AMA Table of Risk in determining the complexity of Medical Decision Making?
How much non-face-to-face time are you typically spending on each patient encounter? Do you use a template for documentation for each level of services? It is important to keep in mind that only outpatient E/M services are impacted by the 2021 changes, including codes 99202–99205 and 99211–99215. As 2021 nears, it will be important to evaluate the pros and cons of each model: using the Medical Decision Making table of risk or total time to select the appropriate code. Check AAN.com/EM often for new tools and resources to help you prepare.
Article Examines Effects of Medicare NCS Reimbursement Reduction The Neurology ® journal published “The Effects of the Medicare NCS Reimbursement Policy: Utilization, Payments, and Patient Access” in its July 17, 2020, online issue. The purpose of the study was to determine whether the 2013 nerve conduction study (NCS) reimbursement reduction changed Medicare utilization,
payments, and patient access to Medicare physicians. The work group performed a retrospective analysis of Medicare data (2012-2016 fee-for-service data from the CMS Physician and Other Supplier Public Use File).
69.3-percent fewer other specialists performing NCS, Medicare access to these physicians for E/M services was not affected. Increased autonomic and evoked potential testing may be an unintended consequence of the NCS reimbursement change.
The study concluded that despite 21.1-percent fewer neurologists, 28.6-percent fewer physiatrists, and
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