The 2021 Current Procedural Terminology (CPT) code set, released last month by the AMA, includes important updates to codes and guidelines for office and other outpatient evaluation and management (E/M) services.
The modifications were designed to make E/M office visit coding and documentation simpler and more flexible. The changes to CPT codes ranging from 99201 to 99215 are proposed for adoption by the Centers for Medicare and Medicaid Services on January 1, 2021.
The E/M office visit modifications include eliminating the history and physical exam as elements for code selection and allowing physicians to choose the best patient care by permitting code-level selection based on medical decision making (MDM) or total time.
Separately, the AMA also is proposing new codes that must be approved by the Centers for Medicare and Medicaid Services regarding COVID-19. One proposal—applicable to physicians engaging in in-person clinical care—is the addition of a new code (99072) to cover the costs of “additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease.”
A second proposal is for the inclusion of an additional code (86413) for laboratory testing of antibodies to COVID-19.
In a September 8 letter to CMS Administrator Seema Verma, M.P.H., the AMA made the following recommendations:
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CPT code 99072 should be immediately implemented to recognize the additional supplies and new staff activities required to comply with providing safe care during the public health emergency.
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Payment for these additional costs should be fully funded and not be subject to budget neutrality. CMS could use remaining funds from the CARES Act to pay physicians for these costs and/or recognize the decreased expenditures during the early months of the pandemic to waive budget neutrality.
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CMS should review the utilization assumptions for equipment due to decreased practice capacity during the COVID-19 pandemic. Any modifications to equipment utilization during the public health emergency should not be subject to budget neutrality.
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CMS should add the costs of N95 masks to the “Medical Supplies Listing” when health care professionals submit physician expenses as part of the Medicare payment formula.
The revised E/M office visit codes are among 329 editorial changes in the 2021 CPT code set, including 206 new codes, 54 deletions, and 69 revisions. Changes to the CPT code set are considered through an open editorial process managed by the CPT Editorial Panel, which includes representatives from APA.
The mission of the CPT panel is to ensure that CPT content reflects the coding demands of digital health, precision medicine, augmented intelligence, and other aspects of a modern health care system. ■
Information about CPT coding and a DSM diagnostic and coding clinic is posted on APA’s website
here.
