New 2021 CPT codes were released in September by the American Medical Association (AMA), aiming to improve patient outcomes for specific conditions, streamline COVID-19 care and reduce physician burnout. As you may know, the Triple Aim targets patient experience, population health and cost reduction. However, the Quadruple Aim progresses a step further, advocating for physician satisfaction and burnout recognition. The AMA’s release of nine codes related to decreasing physician burnout is a big step in the right direction for physicians alike. 

 

Here is a quick overview on what you need to know about the total 329 changes taking effect Jan. 1, 2021. Changes to the CPT guide include the addition of 206 new codes, 54 deletions and 69 revisions. Major changes include the following: 

 

Evaluation and Management Codes (E/M) 

Codes 99202-99215 aim to free physicians from administrative burden and allow more flexibility for care teams and care planning. Note that 92201 has been deleted, it will now be replaced with 92202. 

 

AMA President Susan Bailey, M.D., recommends that clinics prepare to use these codes now, so that when Jan. 1 arrives, clinics can take full advantage of the revisions in practice. 

For New Patients: 

Code Description Time Spent Day of the Encounter
99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. 15-29 minutes
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. 30-44 minutes
99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. 45-59 minutes
99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. 60-74 minutes

 

*For services 75 minutes or longer, consult Prolonged Services

 

For established patients: 

Code Description Time Spent on Day of the Encounter
99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Not specified
99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. 10-19 minutes
99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. 20-29 minutes
99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. 30-39 minutes
99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. 40-54 minutes

 

*For services 55 minutes or longer, consult Prolonged Services

 

Note the definitions of new patients vs. established patients: 

“A new patient is one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.”

 

“An established patient is one who has received professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.”

 

Diabetes Care: 

For clinics with patients living with diabetes, revisions to codes 92227 and 92228, as well as the addition of 92229 are important to take note of. 

CPT code 92229 is to be used for retinal imaging with automated point of care, an augmented intelligence technology. 

All of these codes, the AMA says, should better support the screening of patients with diabetic retinopathy and increase early detection. These codes also seek to incorporate new research findings into diabetic care, for a progressive and technologically-heavy approach to diabetes management strategies. 

 

Cardiac Monitoring: 

 

Codes 93241, 93242, 93243, 93244, 93245, 93246, 93247, and 93248 will replace Category III codes 0295T, 0296T, 0297T and 0298T. These new codes use an “innovative, algorithm technology” to provide physicians with precise data for easier interpretation. 

 

COVID-19

New codes targeted at the COVID-19 epidemic can be used effective-immediately. Codes from earlier this year included codes for diagnostic and antibody testing. Just added, also, are codes for the administering of two coronavirus vaccines, of which the codes are 0001A, 0002A, 0011A, 0012A.

 

How We Can Help

After a particularly taxing year, harmoniously aligning physician burnout and improved patient health — and experience — is more important than ever. Certintell can help your clinic achieve that balance. We work as an extension of your health center, supporting your patients with technology such as telehealth and Remote Patient Monitoring Services. We also alleviate some of your burden by managing a vast majority of administrative work, conducting patient eligibility and performing patient outreach. The next year can be better with a partner — contact us today.

 

 

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