Coding Alert — January 2020

It’s 2020 and time to start getting used to all the new year CPT changes once again. This year the American Medical Association (AMA) has made a total of 394 code changes (248 new, 75 revised and 71 deleted codes).

Technology-Enabled Encounters

A change that will make a big difference in many practices is technology-enabled encounters.

The online Evaluation and Management (E/M) codes for physicians include –

  • 99421 (5 – 10 minutes)
  • 99422 (11 – 20 minutes)
  • 99423 (over 21 minutes)

These codes are to be reported once each seven days. If there are several digital encounters during that period, the time spent can be added together and the total reported under one code.

When the provider is not a physician, the appropriate codes to report are –

  • 98970 (5 – 10 minutes)
  • 98971 (11 – 20 minutes,
  • 98972 (over 21 minutes)

The encounters must be initiated by the patient (parent/guardian) through a HIPAA compliant platform and they must be documented and stored as a face-to-face service would be. The post-op global period applies to digital encounters also, follow-ups to communicate test results from an earlier E/M visit will not be enough to generate these codes. One thing to keep in mind when coding these visits is that a digital E/M may only be charged once every seven days. Unlike the usual office visit, these visits don’t allow for a new problem to result in a new encounter.

Long-Term EEG Monitoring

Another update for 2020 includes long-term EEG monitoring, which has been revamped: 4 codes were replaced with 23 new codes. These codes will increase the specificity of the reported service immensely. They are now broken down by provider level and will allow for more accurate record keeping and appropriate billing.

Evaluation and Management (E/M) Codes

The overhaul of Evaluation and Management (E/M) codes is only a year away – but we’ve been given a sneak peek of what the AMA and Center for Medicare Services (CMS) have in store. Looking ahead at 2021, the codes will be focused on time and medical decision making. Providers will have the discretion to obtain the extent of history and level of physical exam they feel is appropriate for the situation. This will cut down on documentation and time spent counting organ systems reviewed and examined that may not be pertinent to the problem at hand. Both CMS and the AMA have agreed upon the terms, so no more false starts for this overhaul — it’s ready to roll out January 1, 2021.

These are just a few highlights for this year’s coding updates. Please review and become familiar with the changes affecting your practice.

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