Dermatology billing and coding is a very complex process due to detailed reporting, detailed information on procedures, and following multiple procedure rules. These complexities led to a lot of billing and coding errors. Moreover, in the past several time’s multiple changes have been made to dermatology codes, and staying up-to-date with the latest changes is essential for dermatology practices that want to reduce costly denials and improve practice revenue.
Current Procedural Terminology (CPT) Editorial Panel from AMA and the AMA/Specialty Society RVS Update Committee (RUC) are the main contributors for the revisions to office and outpatient evaluation management (E&M).
According to the AMA, four main objectives behind the E&M revision are listed below-
- Reduce the administrative challenges created by documentation and coding
- Reduce the need for audits by adding more detail to CPT codes to promote coding consistency
- Reduce unnecessary documentation that’s not needed for patient care
These changes are in effect from January 1, 2021. So how will this affect dermatologists? After revisions codes will be calculated in two ways time or medical decision-making (MDM).
Moreover, previous code calculations will be changed in certain ways or removed altogether.
Major E/M revisions for 2021
Even though documentation of medically appropriate history and physical examination will still be required, the amount of history or number of elements examined and documented will not factor into the determination of the overall E/M level of service chosen. To this end, the AMA has changed the definition of the time element associated with codes 99202-99215 from typical face-to-face time to the total time spent on the day of the encounter as well as the amount of time associated with each code.
There are no changes to Hospital Observation, Hospital Inpatient, Consultation, Emergency Department, Nursing Facility, Domiciliary, Rest Home or Custodial Care, and Homecare services. Dermatologists who provide E/M services in these settings must continue to report these services using the E/M key components (history, physical examination, and MDM).
Now, we will focus on key changes for each of the E/M service codes and related code descriptors.
Changes in E/M service codes
Understanding these changes is essential to selecting the correct level of E/M service
2021 office visit E/M service codes: Time
|2021 Total Time||Established Patient E/M Code||2021 Total Time|
|99201||Code Deleted||99211||Time Component removed|
|99202||15 – 29 minutes||99212||10 – 19 minutes|
|99203||30 – 44 minutes||99213||20 – 29 minutes|
|99204||45 – 59 minutes||99214||30 – 39 minutes|
|99205||60 – 74 minutes||99215||40 – 54 minutes|
Time = Total time on the date of the encounter (Before face-to-face, during face-to-face, after face-to-face)
Either MDM or total time spent with the patient on the date of the encounter are responsible for coding E/M coding for office, outpatient, or other ambulatory facility visits. At that time, the documentation of a medically appropriate history and physical examination will still be required, but the documentation will not factor into the determination of the overall E/M level of service code choice.
Three elements of MDM
The four levels of MDM include three elements of medical decision making, number and complexity of problems addressed, amount and/or complexity of data reviewed/analyzed, and the risk of complications and/or morbidity or mortality of patient management. Two of the three elements for a level of MDM must be met or exceeded to qualify for each level of service. The combination of these elements determines the E/M level of service reported.
These changes have the potential to benefits physicians or practitioners in many ways however, it takes some time for adjustment. We are experts in dermatology coding and billing services. We employ our extensive experience gained over decades of supporting Dermatology practices.
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