Podiatry Coding & Billing Alert

Remember: You should only use new code +99417 with codes 99205 and 99215.

CPT^® 2021 is here, and these updates will become effective on Jan. 1, 2021. Although you won’t see any podiatry-specific changes, 2021 will be a big year for evaluation and management (E/M) coding. As you’ve learned in past issues of Podiatry Coding and Billing Alert, you will see a major overhaul to new and established patient office/outpatient E/M codes 99202-99215.

Read on to learn more.

Discover New Prolonged Services Code +99417

CPT^® 2021 will add new prolonged services code +99417 (Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each 15 minutes of total time (List separately in addition to codes 99205, 99215 for office or other outpatient Evaluation and Management services).

You should report +99417 “to report prolonged total time (ie, combined time with and without direct patient contact) provided by the physician or other qualified health care professional on the date of office or other outpatient services (ie, 99205, 99215),” according to CPT^®. However, you should only report +99417 “when the office or other outpatient service has been selected using time alone as the basis and only after the total time of the highest-level service (ie, 99205 or 99215) has been exceeded.”

For example, you’ll code an existing patient with an office visit totaling 71 minutes as 99215 and +99417 x 2. The 15-minute threshold does not have to be met in order to report +99417. Rather, you’ll append one unit of +99417 for a visit that falls within 55 minutes to 69 minutes, a second unit that falls within 70 minutes to 84 minutes, and so on.

Caution: You should not report +99417 for any time unit less than 15 minutes. Also, you should never report +99417 in conjunction with codes 99354, 99355, 99358, 99359, 99415, or 99416.

Don’t miss: For all other non-office/outpatient E/M code sets that may be coded based on the 1995/1997 guidelines and time estimate guidelines, you’ll continue to use the existing prolonged services code range +99354-+99357 (Prolonged Service With Direct Patient Contact).

Check Out Revised Codes 99202-99215

Currently, for new patient office/outpatient codes (99202-99205) and established patient office/outpatient codes (99212-99215), you use three key components, history, examination, and medical decision making (HEM) to select the appropriate E/M service level. But, starting on Jan. 1, 2021, CPT^® will remove history and exam as key components for codes 99202-99215. Instead, your code selection will be based upon either the MDM level or the total time the physician spent with the patient on that date of service — not both — just one or the other.

Example: Take a look at the revised code descriptor for 99202 to get an idea of these upcoming revisions. (Emphasis added): Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a medically appropriate history and/or examination and straightforward medical decision making.

• An expanded problem focused history;
• An expanded problem focused examination;
• Straightforward medical decision making.

Counseling and/or coordination of care with other physicians, other qualified health care professionals When using time for code selection, or agencies are provided consistent with the nature15-29 minutes of the problem(s) and the patient’s and/or family’s needs total time is spent on the date of the encounter. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family.

Based on MDM: Based upon the above example, with code 99202, the physician will use straightforward MDM. Also, when you level a service based on MDM, you will want to make sure to check out the new 2021 Level of MDM table.

Based on time: If you level the 99202 service based on time, remember the physician must spend 15-29 minutes total time on the date of the encounter. Each code from the 99202-99215 set will get a specific time threshold in 2021, except for 99211. Also, CPT^® will change the language “typical time” to “total time spent on the day of the encounter.”

Don’t miss: Although history and exam will not be factored into choosing the E/M level for codes 99202-99215, these are still important parts of the medical record, experts say. So, the physician should still perform a “medically relevant history and exam,” as per the code descriptors.

Say Good-bye to This Deleted Code

Starting on Jan 1, you will no longer be able to report 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…) because CPT^® will delete this code.

Because both 99201 and 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making…) involve the exact same type of medical decision making (MDM), having two codes with a straightforward level of MDM was deemed unnecessary. Also, 99201 is not an often-used code, so it makes sense to delete it.