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Coding Roundtable

Educational webinars available for purchase can be accessed here.

Coronavirus Information

Links to CMS guidance on Coronavirus. Please refer to private payer policies for their guidance on coding and billing of Coronavirus.

  1. Coronavirus:

Medicare provides coverage for telehealth under certain conditions, some of which are temporarily different during the COVID-19 pandemic.
https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

***RAC and TPE reviews starting around 08/03/2020
https://www.cms.gov/files/document/provider-burden-relief-faqs.pdf

Coronavirus-Telehealth Services

Coronavirus-covered Telehealth Services – Updated 04/30/2020 can be found at:
https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

Public Health Emergency exceptions – Teaching Physicians and Residents: Expansion of CPT Codes that May Be Billed with the GE Modifier

Teaching physicians and residents: Expansion of CPT codes that may be billed with the GE modifier under 42 CFR 415.174 on and after March 1, 2020, for the duration of the public health emergency:

  • Residents furnishing services at primary care centers may provide an expanded set of services to beneficiaries, including levels 4-5 of an office/outpatient Evaluation and Management (E/M) visit, telephone E/M, care management, and some communication technology-based services
  • This expanded set of services are CPT codes 99204-99205, 99214-99215, 99495-99496, 99421-99423, 99452, and 99441-99443 and HCPCS codes G2010 and G2012
  • Teaching physicians may submit claims for these services furnished by residents in the absence of a teaching physician using the GE modifier

Medicare Administrative Contractors will automatically reprocess claims billed with the GE modifier on or after March 1, 2020, that were denied. You do not need to do anything.

https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-07-09-mlnc  

 COVID Vaccines:

As COVID-19 vaccines are authorized and then recommended for use in the United States, it will be important to understand what is known about each vaccine. CDC will provide information on who is and is not recommended to receive each vaccine and what to expect after vaccination, as well as ingredients, safety, and effectiveness.

Currently, two vaccines are authorized and recommended to prevent COVID-19:

CPT code 91300 with administration codes of 0001A (first dose) and 0002A (second dose).

  • Moderna’s COVID-19 vaccine

CPT code 91301 with administration codes of 0011A (first dose) and 0012A (second dose).

Pending vaccines for COVID:

As of December 28, 2020, large-scale (Phase 3) clinical trials are in progress or being planned for three COVID-19 vaccines in the United States:

  • AstraZeneca’s COVID-19 vaccine
  • Janssen’s COVID-19 vaccine

Novavax’s COVID-19 vaccine​

Popular sites recommended to be bookmarked:

Current Emergencies-
Webpage:  https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page
Partner Toolkit:   https://www.cms.gov/outreach-education/partner-resources/coronavirus-covid-19-partner-toolkit

E/M CHANGES IN 2021

The American Medical Association has provided several modules that explains the Office E/M CPT Code revisions in 2021.  The modules are found at https://www.ama-assn.org/practice-management/cpt/implementing-cpt-evaluation-and-management-em-revisions.

 The American Medical Association has also provided guidance on the selection of the new Office E/M CPT codes effective 01/01/2021: https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf. 

  • E/M Introductory Guidelines related to Office or Other Outpatient Codes 99202-99215
  • Revised Office or Other Outpatient E/M codes 99202-99215. For the complete version of E/M Introductory guideline changes, Office or Other Outpatient (99202-99215) code changes, Prolonged Services code (99354, 99355, 99356, 99XXX) and guideline changes, see Complete E-M Guideline and Code Changes.doc.   Note: this content will not be included in the CPT 2020 code set release

Highlights:

  • 99201 will be deleted effective Jan 1, 2021. The code revisions impact selection of CPT codes 99202-99215.
  • Beginning with CPT 2021 and except for 99211, time alone may be used to select the appropriate code level for the office or other outpatient E/M services codes (99202, 99203, 99204, 99205, 99212, 99213, 99214, and 99215).
  • 2021-AMA will be including rules about shared or split services and time in the CPT book.
  • History and Exam- Codes 99202-99215 may be selected based on time or medical decision making.
    • CPT book will state: “Office or other outpatient services include a medically appropriate history and/or physical examination, when performed. The nature and extent of the history and/or physical examination is determined by the treating physician or other qualified health care professional reporting the service.”
  • Calculating the level of medical decision making to select a code is also revised for 2021.
  • New Prolonged Service Code 99471 and G2212 will be utilized with 99205 and 99215. 

Additional information on 99417 and G2212 can be found at:
https://codingintel.com/are-changes-coming-for-prolonged-services/

Refer to the Medical Decision Making graph: https://www.ama-assn.org/system/files/2019-06/cpt-revised-mdm-grid.pdf

2021 Medicare Physician Fee Schedule Final Rule

Please refer to link from CMS regarding rule updates: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched

 

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