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Medical Billing and Coding Changes in 2021

February 1, 2021

Medical Coding 2021If you’ve been paying attention to any sort of medical billing and coding news lately, you already know that a few large changes are coming in the new year. And they are big ones that will make a difference on how your practice gets paid.

On September 1, the American Medical Association (AMA) released a total of 329 new changes that all providers should expect for 2021. But what are these changes and why do they matter? Here’s what you need to know before they go into effect on January 1, 2021.

Changes to CPT Code Set in 2021

Perhaps the most important of the announced changes are those to the CPT code set. In fact, there are a total of 329 changes that providers need to be aware of heading into January. These include:

  • 206 New Codes
  • 54 Code Deletions
  • 69 Cover Revisions

According to the AMA, the code set changes are designed to bring the process up to current standards and needs, highlighting the increase of certain medical conditions that were previously minimal or grouped in with other codes. There is also a huge emphasis on condition specific codes, both revising existing ones and adding new ones to the code set. Again, these changes take effect on the first day of the new year.

Outpatient Evaluation and Management (E/M) Services

The AMA has also made some large changes to the codes and protocols for outpatient evaluation and management (E/M) services. It’s the first major overhaul the system has seen in over twenty-five years, making it pretty substantial.

Namely, a few of the most critical changes are:

  • The elimination of history and physical exam as elements for code selection with reasoning being that visit time and medical decision making alone should not determine the visit’s code level.
  • Physician choice to decide whether documentation is based on total time spent with the patient or overall decision making time.
  • A migration of decision making criteria to take into account all tasks that affect patient condition management, such as tasks handled not face-to-face.

According to the AMA, they’ve made these alterations to increase physician flexibility and take into account extra tasks that might not have previously been documentable with the previous code set.

COVID-19 Pandemic Code Additions

As expected, the new guidelines also include codes associated with the COVID-19 pandemic. Considering the scope and broadness of the coronavirus crisis, this change for 2021 isn’t much of a surprise to anyone. This is one of the most notable changes to the code set based on a public health crisis.

According to a recent news release from the AMA, these codes are:

  • 99072: Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease
  • 86413: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative

Codes for Continuous Cardiac Monitoring and Detection

The codes for continuous cardiac monitoring and detection are also changing significantly. During the changes for 2021, four codes have been deleted and replaced by eight more. The changes are designed to improve documentation.

Another reason is the increase in technology in this area of medicine. With the updated coding, physicians will be able to include correct coding for a wide range of new advances, including those that use algorithmic technology for more accurate and complete data for physician interpretation.

New Codes for Screening and Care of Diabetes Patients 

There’s no doubt that the dramatic increase of Americans with diabetes has affected the medical industry. To help make the process easier for physicians, the AMA is adding on one additional code and two code revisions specific to the screening and care of these patients.

Codes 92229 for retinal imaging with automated point-of-care, and revision of codes 92227 and 92228 better support the screening of patients for diabetic retinopathy and increase early detection and incorporation of findings into diabetes care.

More Codes Associated with Technological Advances

The biggest takeaway to these changes is that there is more attention to technological advances in the medical field. Instead of having to try to match codes to new methods in patient care, physicians and billing staff now have a greater ability to document the services they’re providing accurately.

Furthermore, there’s an increased emphasis on the fact that not all patient care happens in the doctor’s office. Some tasks, such as coordination of care or telehealth visits, take place at other times and the new coding guidelines now reflect this.

Why You Might Need Help Incorporating These Changes

Let’s face it. Trying to keep up with changes of this magnitude is going to be tough for a lot of medical practices heading into the new year, especially smaller ones. Instead of spending countless dollars and time trying to retrain staff, it might be a good idea to work with a third-party billing specialist like M-Scribe Billing Services.

Our team of medical billing experts is already hard at work learning all of the new changes happening in 2021. By taking the time now to stay on top of it, we’re able to help more medical practices and professionals incorporate them when they take effect in January.

If you’re wondering how you’ll make these changes in your billing practices, now is a good time to find a third-party provider for assistance.

Wrap Up: Medical Billing and Coding Changes in 2021

While most of the world is excited to move into the promise of a new year, medical professionals need to be aware of these major changes happening. These new code additions, revisions, and deletions will make it easier to document patient care, but could cause a few hiccups in the short term as everyone becomes acquainted with the changes.

Are you ready to find out how these billing changes can help you grow your practice in 2021? Please contact our team at M-Scribe Medical Billing Services today for further details.


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