E&M coding changes for 2021

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Thoughts on 99205 + 90833? A few practices I've talked to seem to utilize this for new 60 min intakes but my understanding is you would need to bill 99205 based on MDM. Looking at the definition of high complexity via AACAP, "1 or more chronic illnesses with severe exacerbation, progression or side effects from treatment" OR "1 acute or chronic illness that poses a threat to life/bodily function"

How are people defining the above...or I guess more importantly, how are insurance companies defining the above?

In theory I could see how a new intake for depression, for example, could be defined as an acute/chronic illness that poses a threat to life depending on symptoms (i.e. SI as the most obvious, but also amotivation/sleep disturbances/etc that if untreated would post a threat to function). I could also see anxiety, ADHD, etc falling into this category. It seems like it depends on how 'threat to function' is defined.

Thoughts?

Those actually billing these codes can correct me, but my basic logic for whether it fits the above criteria is just asking: "Are you strongly considering hospitalizing this patient?" If the answer is yes, it probably meets criteria for "severe exacerbation", "progression", or "threat to life/bodily function". I think you can make a solid argument that (almost) anyone you're strongly considering admitting to inpatient has an illness that is putting themselves at risk.

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Regarding the original question, the 2021 CMS E/M codes revision is only for office and outpatient services. Not for psychotherapy codes or inpatient services. Thank you @ramdomdoc1 for sharing the E/M and Psychotherapy Coding Algorithm document. Looks like a great resource.
You can find the Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021 here. It seems like they added a few telehealth codes for group psychotherapy and psychological and neuropsychological testing.

Before these new guidelines, you typically determined the appropriate level of E/M service based on three key components: history, examination, and medical decision-making. Or, if the encounter was dominated (>50%) by counseling and/or coordination of care, you could bill based on time. The way we now determine the level of the visit changed. Now we need to document only interim or pertinent history and relevant physical exam findings. The way you determine time also changed. I looked into this and wrote an article in my blog and summarized into a video >

2021 CMS E/M CODES REVISION FOR OFFICE AND OUTPATIENT SERVICES

I also created a little app > E/M Coder

Hope you find them useful.

Beware of the AMA videos, while they are a great resource, they are a year old and have some outdated content. You will see a BIG yellow warning on slide 15 of the presentation. The AMA published an updated document with the final coding guidelines changes.

Sharing other good news. The RVUs for E/M codes increased. Check out this table from the AAPC >
Work RVUs for 2021 Office/Outpatient E/M Codes

To account for changes in RVUs including significant increases for E/M visit codes, the final CY 2021 PFS conversion factor is $32.41, a decrease of $3.68 from the CY 2020 PFS conversion factor of $36.09.
 
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do psychotherapy add on codes have same wRVU values?
 
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do psychotherapy add on codes have same wRVU values?
Same as what? Their values are the same as last year if that's what you're asking (unchanged).
 
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Anyone have success getting reimbursed for 99417 yet? If so, in what context?
 
Anyone have success getting reimbursed for 99417 yet? If so, in what context?
my hospital set it's wrvu value to zero so now i never use it
 
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Anyone have success getting reimbursed for 99417 yet? If so, in what context?
I get reimbursed for this in neurology but not billing in psychiatry. Just goes to show you that parity is still something we are a way off from

exception is Medicare does reimburse for G2212 for me which is the CMS equivalent of 99417. Medicare is also a reliable payer of the other prolonged services codes for me.
 
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