We are well into 2021 and with new changes to the CPT® code set that went into effect on January 1, it’s important to make sure your medical practice acts now. Among the 329 editorial changes are 206 new codes, 54 deletions, and 69 revisions–each of which your practice must be compliant with.
If you have yet to make sure your Evaluation and Management rules are up to snuff for 2021, there’s no time like the present. All health plans must use the updated version of the code set (The U.S. Department of Health & Human Services’ (HHS) Healthcare Common Procedure Coding System (HCPCS)) which is the standard medical data code set in the United States.
CPT Code Changes: Overview
Here’s a quick overview of some of these changes:
- Eliminating the CPT code 99201
- Changing the RVU values for E/M and other CPT codes
- New documentation standards clinicians to use either medical decision making (MDM) or time-based for services provided
- The Medicare Conversion Factor went from $36.0896 in 2020 to $34.8931 in 2021
Keep in mind, unless and until your practice is compliant with these updated documentation methodologies, you won’t be receiving the proper reimbursement for the services you provide. Not to mention, some of these changes have implications for physicians whose compensation is tied to RVUs in addition to how they affect reimbursement.
E/M Office Visit Modifications
As outlined by the American Medical Association, these changes include a number of implications of E/M office visit modifications, including:
- “Eliminating history and physical exam as elements for code selection
- Allowing physicians to choose the best patient care by permitting code level selection based on medical decision-making (MDM) or total time
- Promoting payer consistency with more detail added to CPT code descriptors and guidelines.”
COVID-19 Coding
It will come as no surprise that some of the additions to the CPT code involves the new medical testing services that are part of the public health response to COVID-19. In addition to code additions, there are many code revisions related to COVID testing that went into effect on January 1 along with the other changes.
In addition to coding changes for COVID-19 testing, there are also a number of changes for vaccinations. These include unique codes for each specific COVID vaccine, as well as the corresponding codes for administration of the vaccines.
These new codes are vital for the appropriate tracking and distribution of these vaccines, and it’s important for practices and clinicians to get caught up with them as quickly as possible. To get started, you can read a summary of the SARS-CoV-2 related CPT codes here.
How RevStream can help
Ensuring compliance is just one of the benefits of entrusting your revenue cycle management services to RevStream. To learn more about our RCM services for ABA therapists, chiropractors, orthopedists, pain management, physical therapists, and primary care physicians, click here. Or, use this link to contact us with your questions today.
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