Enter’s billing team assembled this Blog Post for all Providers in the USA to gain insight on updates to 2021 coding rules. 

Time Based Billing

Time is Allowed on Non-Counseling Dominated Visits - New 2021 CPT changes allow you to choose a level of E/M based on total time for E/M service OR level of medical decision making.

Medicare Telehealth & Services Involving Communications Technology (CTBS)

Telehealth is growing at the fastest rate in all of medicine. This may be one of the largest benefits and bright spots to emerge from the Covid-19 pandemic. The reduction in regulations is allowing Patients to get access from anywhere. Here is some new guidance on Medicare’s Professional Fee Schedule (PFS) and how to bill and code for Telehealth and Services Involving Communications Technology (CTBS):

To account for significant Evaluation and Management (E/M) codes Relative Value Units (RVU) increases, the final conversion factor is $32.41. 

New Prolonged Service Codes

Prolonged Services with Direct Patient Contact are when a physician or other qualified healthcare professional provides prolonged services beyond the usual service in either the inpatient or outpatient setting.

  • Prolonged services codes currently in effect do not go away and they will not be associated with office/outpatient code set.  The new 15-minute increment code 99417 will be reported ONLY when the visit of the highest-level service (99205 or 99215) based on time total time has been exceeded. 
  • Each unit of 99417 equals 15-minutes and must be 15-minutes in order to bill one unit of the code.
  • For Medicare Patients, the use of G2212 is to be used for EM patient visits.
  • The below chart gives examples of how to use the code:

New Prolonged Service Codes

These codes are applicable specifically for Prolonged Wellness Visits 

2021 Time Includes

Take advantage of time based coding by documenting every minute spent for the below activities.

1 - Prep-Work

  • Preparing to see the patient (eg, review of test)
  • Obtaining and/or reviewing separately obtained history.

2 - Exams

  • Performing medical exam and/or evaluation
  • Counseling & educating patient/family/caregiver.
  • Ordering medications, tests, or procedures.

3 - Follow Up

  • Documenting/charting in EMR
  • Referring & communicating with other health care professionals (when not separately reported.)
  • Independently interpreting results & communicating results to patient/family/caregiver (when not separately reported.
  • Care Coordination (when not separately reported),

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