Ophthalmology and Optometry Coding Alert

Check the expert answers to ensure you’re coding correctly.

Do this: Turn your attention to the following three questions, as well as the associated answers, to see what you still need to learn.

Question 1: Which Codes are Impacted?

Specifically, which E/M codes are revised, deleted, or added in CPT^® 2021 that will change how you code common services that your physicians provide?

Caveat: Let’s ignore, for now, code revisions under Care Management Services or Prolonged Services — we’ll cover those more in depth in a future issue, since the 2021 Medicare Physician Fee Schedule debuted new Medicare-specific codes for some prolonged services.

Answer 1: Just Office or Other Outpatient

Keep in mind that the E/M changes only apply to the outpatient visit codes 99201-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …).

Key changes: Nine code revisions, one deletion, and one addition embody the coding overhaul, as follows:

Revise: Code descriptors for 99202-99215 change in the following ways:

• Drop levels of history and examination in favor of requiring a “medically appropriate history and/or examination;”
• Delete information about the usual severity of the presenting problem, focusing instead on the complexity of the provider’s work; and
• Base code level on provider’s medical decision making (MDM) or base code selection on time alone.

Delete: CPT^® 2021 deletes 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. … Typically, 10 minutes are spent face-to-face with the patient and/or family), making 99202 the lowest level for new patient office visits.

There’s a simple reason for this change. “When the history and exam components are removed from the E/M level calculation, there is little left to distinguish 99201 from 99202,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, billing specialty subject matter expert at Kareo in Irvine, CA. “Both 99201 and 99202 describe straightforward MDM, which is now a primary criterion for code selection,” she adds. The only difference remaining between deleted 99201 and revised 99202 is time, and we’ll discuss that in the next question.

Stays the same: Observation or inpatient service codes that rely on the components of history, exam, and MDM to determine levels have not been affected and will continue in their current form for the foreseeable future.

Question 2: How Does ‘Time’ Change in 2021?

Which of the following items change regarding the time element for each office or other outpatient E/M code in 2021 — how you use time to select a code, the number of minutes in the code definition, what services you can count toward time, or how to report extended visits?

Answer 2: All of the Above

CPT^® 2021 upsets the apple cart for how you’ll use “time” to report office or other outpatient E/M services. Read on to answer the question.

First: You can choose to report the appropriate code 99202-99215 based on MDM or on time alone, whether or not you meet the old requirement that counseling and/or coordination of care dominates the service.

Second: The number of minutes included in the code descriptors changes for each code 99202-99205 and 99212-99215 in 2021. Additionally, prior to January, time was used as a “typical” time. Instead, CPT^® 2021 lists a total time range for each code. For instance, 99212 used to be a “typical” 10 minutes, but now the code identifies the total time range of 10-19 minutes.

Third: “CPT^® is changing the definition of the time element associated with 99202-99205 and 99212-99215 from typical face-to-face time to total time spent on the day of the encounter,” according to Rae Jimenez, CPC, CIC, CPB, CPMA, CPPM, CPC-I, CCS, senior vice president of product at AAPC and coding liaison to the AMA CPT® Editorial Panel. Total time could include face-to-face time, as well as time spent ordering diagnostics, coordinating care after the encounter, or even writing documentation — but not time spent by non-billable staff.