APMA News - September/October 2020 - 29

Reimbursement
Major changes to the way physicians get reimbursed on
office/other outpatient E/M codes are coming January 1,
2021. It must be stated that this is a CPT change, not a specific payer change. Therefore, this update applies to all
third-party payers, including Medicare.
CPT 99201 is being deleted and so will no longer be a valid code to bill after January 1, 2021. In an effort to phase in
the E/M changes gradually, the only E/M codes affected in
2021 will be the office/other outpatient E/M codes-what
many of us think of as "office visits":
NEW PATIENT: CPT 99202 - 99203 - 99204 - 99205
ESTABLISHED PATIENT: CPT 99211 - 99212 - 99213 -
99214 - 99215
The most substantial change will be elimination of the history and physical exam components in determining the level
of the code. The level will be selected based only on medical
decision making, which includes number/complexity of
problems addressed, amount/complexity of data to be reviewed and analyzed, and risk. A history and an exam should
certainly be performed, as they are good medical and legal
practice, but they will not be required for code level selection
purposes. Because the level will be selected on medical decision making, without exam bullet restrictions, the potential
positive effect on podiatric practices should be significant.

Here is an example: A new patient is sent over to you
from their PCP with a complaint of a worsening, draining
wound from the plantar aspect of the foot. Intense erythema extends from the wound to the ankle. There is a lot of
swelling and warmth. The patient describes a fever and a
feeling of malaise. You spend time explaining their condition and the at-risk status of their foot and health. You
decide to admit the patient for IV antibiotics and further
work-up. Based on your recorded documentation, a new
patient level CPT 99205 could easily be achieved on this
patient after January 1, 2021.
More articles are forthcoming with more specific information about the 2021 E/M changes. Be sure to check www.
apma.org/coding often for further information on all the
changes coming for 2021.
Reference:
AMA CPT® Editorial Summary of Panel Actions February
2019: https://www.ama-assn.org/system/files/2019-03/february2019-summary-panel-actions_0.pdf
Current Procedural Terminology (CPT®) is copyright 1966,
1970, 1973, 1977, 1981, 1983-2019 by the American
Medical Association. All rights reserved. CPT is a registered
trademark of the American Medical Association (AMA). n

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APMA News September/October 2020

http://www.apma.org/coding http://www.apma.org/coding https://www.ama-assn.org/system/files/2019-03/february-2019-summary-panel-actions_0.pdf https://www.ama-assn.org/system/files/2019-03/february-2019-summary-panel-actions_0.pdf http://apma.officialbuyersguide.net

APMA News - September/October 2020

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