Prep Your Cardiology Practice for E/M Changes in 2021

Prep Your Cardiology Practice for E/M Changes in 2021

Time for codes 99202-99215 will be redefined as the total time spent on the day of the encounter.

In 2021, you will see big changes to new and established office/outpatient evaluation and management (E/M) codes 99202-99215. To help your practice prepare for these changes, AAPC will hold a series of in-depth, online workshops this year.

Read on to learn how these 2021 E/M changes will impact your cardiology practice, as discussed in the AAPC webinar “E/M Guideline Changes: Cardiology.”

Identify Major Change to Leveling 99202-99215

Currently, for new and established patient office/outpatient codes 99202-99215, you use three key components — history, examination, and medical decision making (MDM) — to select the appropriate E/M service level.

Starting Jan. 1, 2021, CPT® will remove history and exam as key components for leveling codes 99202-99215. Instead, you will base code selection on either the MDM level or the total time the physician spent with the patient on that date of service. Along with this change, CPT® will also update the guidelines pertaining to time and MDM.

The E/M 2021 changes will only apply to specific codes: new and established office/outpatient E/M codes 99202-99215. For example, if your cardiologist sees patients in the hospital, their office, and a nursing facility, only the visits in the cardiologist’s office will be held to the new guidelines. Codes in the other E/M categories will not use the new 2021 guidelines.

To learn more about how the E/M 2021 changes will apply to cardiology practices, check out the AAPC webinar “E/M Guideline Changes: Cardiology”. Register for other specialty-specific E/M 2021 webinars here.

Take a Look at New Code Descriptors

To better understand this switch to MDM or time for leveling codes 99202-99215, look at the current and revised code descriptors for 99203:

  • Current 2020 descriptor: 99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity…
  • Revised 2021 descriptor: 99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter

The revised 99203 descriptor tells you some important information. If you choose to level this service based on MDM, 99203 requires a low level of MDM. To use time to level the service, the provider must spend 30-44 minutes of total time on the date of the encounter. And, lastly, “a medically appropriate history and/or examination” is required.

Note: Although you won’t level codes 99202-99215 based upon history and exam in 2021, this does not diminish the importance of these components. Providers should still perform a medically relevant history and exam. Even though they will not be used as leveling components, the history and exam will still be important parts of the medical record.

Time Gets a Makeover in 2021

In 2021, for codes 99202-99215, CPT® will redefine time as the total time spent on the day of the encounter, rather than just face-to-face time. This will allow you to calculate pre-time, post-time, and time spent with the patient during the encounter for codes 99202-99215.

According to the new guidelines, this total time can include the following activities:

  • Preparing to see the patient (e.g., review of test results)
  • Obtaining and/or reviewing a separately obtained history
  • Performing a medically appropriate examination and/or evaluation
  • Counseling and educating the patient/family/caregiver
  • Note: This is not an exhaustive list.

Remember: As you can see from the above examples, the total time can include both face-to-face and non-face-to-face time. However, this total only includes time spent on the date of service.

Additionally, CPT® will change the standard time threshold for each of these codes. For example, in 2021, the range for 99202 will be 15-29 minutes and the range for 99212 will be 10-19 minutes.

Coding example: An established patient presents to the cardiologist’s office for a follow-up appointment for hypertension. The cardiologist spends five minutes reviewing the lab test results performed since the last visit. The cardiologist spends nine minutes with the patient obtaining an appropriate medical history and reviewing vital signs. The cardiologist also reviews the patient’s current medications, submits refills to the pharmacy, and has the patient scheduled for a follow-up visit in three months. The cardiologist documents the encounter in the electronic health record during this face-to-face encounter.

Coding: Report 99212 for this encounter. You are leveling this service for an established patient based on time; and the 14 minutes spent on this encounter falls within the time range for 99212.

Master New MDM Guidelines

The MDM elements will also be revised in 2021. To qualify for a particular level of MDM, you must meet or exceed two of the three elements for that level of MDM. The recognized types of MDM are straightforward, low, moderate, and high.

Take a look at what the new criteria for MDM will be:

  • The number and complexity of problems addressed during the encounter
  • The amount and/or complexity of data to be reviewed and analyzed
  • The risk of complications, morbidity, and/or mortality of patient management

Here’s an example of how to level a service based on MDM in a cardiology practice next year:

S: Patient seen today in a follow-up to recheck right internal carotid artery stenosis. On 08/23/xx, had normal left internal carotid artery and 30% stenosis of the right internal carotid artery, which is asymptomatic. Today, no symptoms of TIA, CVA, or amaurosis fugax. Denies headaches.

O: General: No acute distress, pleasant, alert, and oriented times 3. Speech is normal. Voice is normal. WT: 129. BP: Right arm 175/69, left arm 168/62. HR: 84. TEMP: 97.8. Chest: Clear to auscultation bilaterally, normal effort. Heart: RRR. Easily palpable bilateral carotid pulses with no jugular venous distention. Pedal pulses normal. Moves all extremities with 5/5 strength. No edema. Skin: WNL.

VASCULAR STUDIES: Duplex examination of right carotid artery on 03/17/xx reveals 50-60% stenosis right internal carotid artery.

A: Per ultrasound increase from 30% to 50-60% stenosis, which is asymptomatic.

P: I would like to get an MRA of the neck and see the patient back in one week to review results.

Coding: The number and complexity of problems addressed here are low. The patient has one stable, chronic condition. For the amount and/or complexity of the data, the cardiologist reviewed the ultrasound and ordered a neck MRA, so the data is limited and the level of risk is low. Since this is an established patient, the correct code is 99213.

Evaluation and Management – CEMC

Meagan Williford, MA, CPC-A
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Meagan Williford, BA, MA, CPC-A, is the development editor for TCI’s newsletters Cardiology Coding Alert, Podiatry Coding and Billing Alert, and Neurosurgery Coding Alert.

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