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AAAAI Practice Management Resources

Coding

Coding

The AAAAI offers coding resources for the practicing Allergist / Immunologist. Check-back often to review recently asked coding questions. For specific coding questions or concerns, contact coding@aaaai.org.

AAAAI does not assume and it hereby disclaims any and all liability to any person or entity for any claims, damages, liability or other loss (including, without limitation, any liability for injury or other damage resulting from any use of or reliance on this service or from the posting or transmission of any information, content or material on this service by AAAAI, or any third party). By using this service the user releases AAAAI and its directors, officers, members, or agents from and against any and all such liability. The user assumes all risks of using the materials included in this service.


2021 E/M & Coding Webinar – Practical Tips for your Practice
As part of its efforts to reduce burden and improve payment for cognitive care, the Centers for Medicare and Medicaid Services (CMS) implemented key changes to office and outpatient evaluation and management (E/M) services, effective January 1, 2021. Watch this January 26, 2021 webinar featuring renowned AAAAI Coding Consultant Teresa Thompson, BS, CPC, CMSCS, CCC, for key changes in documentation of office and outpatient E/M services you need to make now.

2021 E/M Coding Update Practice
The AAAAI has created this online opportunity to practice evaluating patient cases and coding visits based on medical decision-making and/or time.

January 14, 2021
On January 14, 2021, the Centers for Medicare and Medicaid Services (CMS) released a fact sheet, Physician Fee Schedule (PFS) Payment for Office/Outpatient Evaluation and Management (E/M) Visits, that provides additional information and guidance on recent changes to E/M services as a result of the CY 2021 PFS final rule.

Complex Care Add-on Code
In the CY 2021 PFS, CMS finalized an “add-on” code for visit complexity, HCPCS G2211. However, payment for the code was delayed under the Consolidated Appropriations Act, 2021, until January 1, 2024 or later. According to the CMS notice, “Practitioners may report this code for qualifying visits furnished on or after January 1, 2021, although we assigned a PFS payment status indicator of ‘B’ (Bundled) until 2024.”

Implementation of this add-on codes is anticipated to increase reimbursement for Allergy/Immunology professionals and other cognitive specialties. Therefore, we encourage AAAAI members to report this code with their E/M services (i.e., CPT 99202 – 99215). This will help CMS understand how the code would be used, as well as revise its budget neutrality estimates when the code is able to be reimbursed in CY 2024.  

Medical Review of E/M
CMS also discusses medical review when practitioners use time to select visit level, stating that, “Our reviewers will use the medical record documentation to objectively determine the medical necessity of the visit and accuracy of the documentation of the time spent (whether documented via a start/stop time or documentation of total time) if time is relied upon to support the E/M visit.”

It is necessary to appropriately document time in the medical record when it is used for E/M code selection. This may be supported through available audit tools as part of an electronic health record (EHR).

December 17, 2020
In anticipation of revised 2021 Evaluation/Management (E/M) codes, the AAAAI offers these current and anticipated resources:

Effective January 1, 2021, the Current Procedural Terms (CPT®) codes 99202-99215 will no longer require history components and/or exam components to determine the level of code to be selected. Changing these documentation requirements will reduce note “bloat” without impeding good patient care.  The provider will need to document only relevant history and perform only relevant exam(s), necessary for appropriate patient care, as determined by the provider reporting the service.

In 2021, CPT code 99202-99215 selection will be based on either medical decision-making or time. The provider reporting the service will have the option to choose either time or medical decision-making to support the reported E/M level.  Time will now be total time spent on the date of the encounter involving the provider’s time whether it is face to face time or non-face to face time involved in the patient’s care.

These changes reflect the goals of the 2017 Patients Over Paperwork initiative as advanced by the Centers for Medicare and Medicaid Services (CMS) to:

  •  Put patients first;  
  •  Establish internal processes to evaluate and streamline regulations;
  • Enhance efficiency; and,
  • Improve the patient experience

With goals to:

  • Bring satisfaction to users (clinicians, institutional provide  health plans etc.)
  • Reduce the amount and hours spent on CMS-mandated compliance
  • Increase the number of tasks CMS customers can do digitally

In 2020, the American Medical Association followed the lead of CMS and changed the requirements for New and Established patient evaluation and management codes [99202-99215]. The real benefit and driving force behind Patients Over Paperwork is optimizing workflows so that clinicians can focus on patients, not paperwork.

Check-back often for new information and to review recently asked coding questions. For specific coding questions or concerns, contact coding@aaaai.org.

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