All Posts in Category: ICD

2021 Evaluation and Management (E/M) Code Changes

2021 Evaluation and Management (E/M) Code Changes

Each year, a number of Evaluation and Management Code Changes are announced, and these E&M code changes must be adhered to throughout the calendar year and beyond, unless they are superseded by later changes. For calendar year 2021, the E&M code changes described here will be in effect, and must be used by medical personnel when making any kind of medical claims. Excerpts from the code changes document issued by the American Medical Association pertaining to this year’s changes are included below. This kind of uniformity is of course necessary, so as to avoid total chaos in the realm of medical billing

Coding changes regarding time 

It is necessary to include time as a factor in medical claims, so as to determine the most appropriate type of medical service. For some outpatient services, it will be possible to use time by itself as the appropriate code level, for instance using codes 99202, 99203, 99204, 99205, 99212, 99213, 99214, and 99215. Since most categories of service use time in a different way, it becomes important to review and understand the instructions for each of these categories. It is often difficult to provide precise estimates of the time which is spent on a face-to-face basis with any patient, because it happens fairly often that patient encounters occur on multiple occasions and for varying amounts of time. For those medical codes mentioned above, time should be considered the total face-to-face time on the actual date of any patient encounter.

Additionally, there was a significant change to the Evaluation and Management Code effective January 1, 2021. CPT code 99201 will be deleted. For new patient codes, times begin at 15–29 minutes for CPT code 99202 and then advance in 15-minute increments with 99205 assigned 60–74 minutes. For existing patients, the time element was removed from CPT code 99211.

Separately reported services 

It is allowable to report any specifically identifiable procedure separately, as long as it was performed on the date of the E/M services. For example, any physician-administered diagnostic tests for which CPT codes exist can be reported separately, and it is also allowable to claim the time needed to interpret the results of those diagnostic tests. Any tests or interpretations which are not reported separately, will be considered standard decision-making on the part of the physician. 

Examinations and patient histories 

Patient examinations can be reported, using the appropriate codes, as can interviews which constitute a review of the patient’s medical history. It is at the discretion of the physician what the nature and extent of such interviews should include, and information can be gathered both verbally, and through questionnaires or other written vehicles. Patient portals may also be used in the gathering of patient information, provided that it relates to the patient’s medical background, and will be considered during future treatments.

Number of issues addressed, and levels of complexity 

It is entirely possible that several issues will be addressed during a single medical encounter with a patient, and these issues may be characterized by varying degrees of complexity. There are specific guidelines which relate to the complexity of any issues which might be treated during a patient encounter, and that of course will impact the medical billing code used. As an example, a chronic illness would be handled in a different manner than an acute illness would, and that means different billing codes must be used when making any claims. 

Office and outpatient services 

A patient is considered an outpatient until he/she is admitted to a healthcare facility as an inpatient. Care must be taken to use the appropriate billing codes to reflect this potentially changing status. There is a complete set of codes which can be used for delivering outpatient services, just as there are corresponding codes which must be used for observation care, for inpatient services, discharge services, and for any kind of services which are provided in the emergency room.

New Patients

The billing codes used to cover new patients are 99202-99205, and they are reflective of the length of time necessary to conduct a physical examination of the patient, as well as to conduct some kind of interview regarding the patient’s medical history and background. The different codes are used so as to denote the length of time which was necessary to accomplish the exam and patient history interview. For example, code 99202 would be used for a session which lasted between 15 and 29 minutes, whereas 99205 would be used for a session between 60 and 74 minutes duration.

Established Patients

In the same way that several different billing codes are used to represent the time needed for a session with a new patient, a set of different codes must be used for sessions with established patients, those being 99211-99215. Each of these will also represent varying lengths of time necessary to deliver services to the patient at the session, with 99212 being used for 10-19 minutes of time and 99215 being used when the time required falls between 40 and 54 minutes.

Prolonged Services 

It will be necessary to use billing codes 99354 thru 99357 when the services delivered to a patient are considered to be beyond usual service, either in an outpatient setting, or an inpatient setting. These are face-to-face services which include other services not considered face-to-face, such as those which might be administered in a hospital setting or a nursing facility. These are services which can be reported in addition to primary services offered, and it will be necessary to choose the correct billing codes when claiming such services as supplies provided to the patient, or other procedures which are performed on the patient during this period.

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ICD-10 Changes Are Coming: What You Can Do to Be Prepared

ICD-10 ChangesThe ICD-10 release date is fast approaching. October first will be here before we know it. However, there is still plenty of time to prepare for this enormous change. To make the adjustment as smooth as possible for you and your employees, there are some steps your practice can take now in preparation.

Train Now

            The best thing you can do to prepare is to make sure your staff understands ICD-10. The sooner you start training them, the sooner they will begin to understand the new system.   All members need to be on board with this, as this is an extremely large change. There are plenty of programs and classes you can purchase that will help train your practice for the impending changes, or you can choose to learn the coding yourself and relay that information to your employees.

Learn the Most Important Codes

            With ICD-9, many practitioners have all of the codes memorized because of the frequency in which they use them. Because of its complexity, ICD-10 will be more difficult to memorize. The codes have 5-7 digits per code, an increase from the current 3-5. Prioritizing codes that will be used frequently makes the task of memorizing them a lot less daunting. It is important to pay attention to what codes are used more often than others and make sure you have those down. The sooner you begin working on memorizing common codes, the easier the transition will be.

Build a Communication Team

Strong communication is what will make the transition smooth and manageable. To ensure that your practice has open lines of communication, you’ll need to build a communication team. A project manager needs to be established. This person will need to be the resident expert of the system and be able to answer any questions that arise. They’ll also need to have a contact person outside the office who fully understands and has mastered the program. Having many people who have a strong understanding of ICD-10 can only help everyone get onboard with the transition.

There are many ways to prep for ICD-10. The more time you spend preparing for ICD-10 before it is enforced will mean the less time you spend struggling to understand it later on. This is a great advancement for the medical field and can only get better.

What steps is your practice taking to prepare for the upcoming ICD-10 changes?

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What Is ICD-10?

What Is ICD-10?

ICD-10 is the tenth revision of the International Classification of Diseases, or ICD. The ICD is the standard diagnostic tool for health management, clinical and epidemiological purposes, and it is used by doctors, nurses, policy makers, researchers and other health care experts to classify diseases and other health issues. It’s also used to monitor the general health situation of population groups.

The ICD-10 was endorsed by the 43rd World Health Assembly in 1990, and it has been in use in World Health Organization states since 1994. Despite this long history, the ICD-10 is still being updated through an ongoing revision process. Transition to the latest version of ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act, or HIPAA. The release date of ICD-11 is scheduled for 2017.

Differences Between ICD-9 and ICD-10

The biggest differences between ICD-9 and ICD-10 is in the diagnosis code set. Where ICD-9 had five positions in its code set, ICD-10 has been expanded to include seven positions. The number of diagnostic codes has also been increased from 13,000 codes in ICD-9 to 68,000 codes in ICD-10. These updated codes are far more accurate than they’ve been in the past and allow for more specific reporting and diagnosis.

The problem with companies that still need to make the transition to ICD-10 from ICD-9 is that there is no clear mapping between the two. There are some codes in one system that corresponds to others, but for the most part any organization that needs to upgrade to using ICD-10 will need to do so almost from scratch.

Why the Change Needs to be Made

The medical field is changing drastically all the time. New disorders and diseases are being discovered, new treatments are being developed and new medical devices have been put into use. The changes made in just the last 25 years have been incredible, and things will continue to change more quickly than ever before. The ICD-9 system was not designed to keep up with that kind of progress, so a newer system such as ICD-10 needs to be put into place.

However, staying HIPAA compliant and upgrading to ICD-10 isn’t enough. As we said before, ICD-10 is constantly under revision, and that means that organizations that use it have to keep it updated. That has become easier now that ICD-10 is available online, but it still takes a lot of work to stay up to date.

We at Medical Healthcare Solutions know how important it is that any organization covered by HIPAA has the latest version of ICD-10. We do our best to stay on top of all forms of medical coding even as they are constantly changing, and we always do what we can to be aware of changes and updates before they are made. We also do our best to remain HIPAA compliant in every way, and we can help other organizations do the same. If you would like to know more about how we keep ICD-10 properly updated and implemented, contact us today or visit us online.

If you’re interested in learning more about how Medical Healthcare Solutions can prepare your practice for the upcoming ICD-10 changes please contact us at 1-800-762-9800 or by filling out this form.


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