Changes to the way eye care codes are utilized have taken effect

The year 2021 is finally here, and with it changes to the CPT E/M codes. The entire summary of said codes can be found in this column.

Before you dig in, I recommend you print this document, and keep it handy for reference. Your team may enjoy the simple way we summarize the changes.

WHAT IS THE SAME

• You can still use the level of medical decision making for selecting your E/M code.
• You can still bill for telehealth using E/M codes as you did under the telehealth waiver in response to the emergency rule.

WHAT HAS CHANGED

• Total time spent with the patient can now be used to select an E/M code (see bit.ly/AMAEM2021 ).
  Helpful hint: If you are using E/M coding based on total time spent with the patient, please make sure you document that in your medical record for audit purposes. Be careful to be accurate with this, as it will not be difficult for an auditor to look at an appointment book (or phone record, if telehealth visit) to verify time spent with patients.
• It is likely that CMS will expect you to use the total time E/M codes for telehealth visits going forward (watch for more on this).

READ AMA GUIDANCE

A few things to keep in mind when looking at this (bit.ly/AMAEM2021 ) document:

• Time spent with the patient is included in the definitions; this has been the case since 1992. The difference for 2021 is that time alone may be used to select the appropriate E/M code level for the office E/M service code.
• If other tests are billed for the same day of service as the E/M code, the time spent performing and/or interpreting the diagnostic tests are not included in determining the level of the E/M service.

The basic criteria now for selecting a level of office visit E/M service is one of the below:

1. The level of medical decision making as defined for each service or
2. The total time for E/M services performed on the date of the encounter.

• The referenced document outlines the description of medical decision making as well as provides a chart that you can use for reference.
• Description of “new” and “established” patient has not changed, and the time required for each code, if using time for your choice of E/M code, is included as well.
• 99201 has been deleted. Coding begins at 99202.
• 99211 is used when the qualified health care professional’s time is spent in supervision of clinical staff who perform the actual face-to-face services of the encounter.

VERIFY WITH EHR COMPANIES

Check with your EHR company to see what changes they have made to make you compliant with these new rules, and with your team to ensure understanding. 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.