Changes proposed for 2021

On Sept. 1, the American Medical Association (AMA) announced its first major overhaul of the CPT code in 25 years had concluded. This overhaul, they say, is to the codes and guidelines for outpatient E/M codes.

Be forewarned that these proposed changes may or may not go into effect as planned Jan. 1, due to the state of emergency created by COVID-19. (More on the coding implications of the emergency declaration can be read in previous columns: bit.ly/Coding820 , bit.ly/Coding620 and bit.ly/Coding520 .)

However, the reason for this article is to make everyone aware of the possible changes and to be on the lookout for more information, as we approach 2021.

CPT CHANGES

The changes made, according to AMA, are designed to create a simpler and more flexible documentation requirement to CPT codes, ranging from 99201 to 99215. Again, these changes are proposed for adoption by the CMS on Jan. 1. (Read more about this process at bit.ly/2FhbxcL .)

ACTIONS STEPS

We should:

 Check back monthly,  

 

Purchase a 2021 CPT coding manual and 

 

  Read the updates we receive from each insurance company. 

According to an AMA article, the proposed changes to the E/M codes include:

• “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.”

As might be expected, some additions to the CPT codes are a direct result of the new medical testing services that have been developed because of the public health response to COVID-19.

ADDITIONAL CODE

Specific to eye care is the addition of code 92229 for retinal imaging. The AMA states that “Innovative solutions like the augmented intelligence technology described by new code 92229 have the potential to improve access for at-risk patient populations by bringing retinal imaging capabilities into the primary care setting.”

STAY TUNED

Stay tuned as we draw closer to 2021, and don’t forget that all of this is tentative and dependent on where we stand specifically in regard to the state-by-state “State of Emergency,” due to COVID-19. The other important factor is how quickly each insurance plan adopts these changes. OM

DR. JASPER practices in West Palm Beach, Fla. She is an American Academy of Optometry fellow and is chief optometric editor of Optometric Management. Email her at april.jasper@pentavisionmedia.com.