Is Your Practice Ready for the Change in Medical Billing?

January, 3 2021 
By New England Accounts Receivable Management


Although the AMA has announced a new CPT code, 99072, allowing practices to bill for additional supplies used in their practice to treat Covid 19 patients, a survey of the obvious carriers, Medicare and Blue Shield, indicated that the payers will not currently reimburse for this code. We will continue to watch for any carrier information that may change this decision.

On the other hand, the new guidelines for coding Evaluation and Management codes should make everyone a bit happier! The codes have now been assigned a time guideline that should help everyone code a lot easier without the tedious test of Medical Decision- Making guidelines of the past. The new time guidelines state the MDM for you while giving you the total minutes per visit. If you decide not to use the time elements, you may continue to decide level of coding the same way you have in the past.

The new requirements for E/M codes using time for a New Patient Exam are:

99202 History/Exam Straightforward MDM 15-29 minutes

99203 History/Exam Low MDM 30-40 minutes

99204 History/Exam Moderate MDM 45-59 minutes

99205 History/Exam High MDM 60-74 minutes

    • For prolonged services above 74 minutes, there will a new add on code created. Until such time, Code 99XXX is appropriate to be used with 99205
    • Note that code 99201 has been eliminated as the MDM is the same as 99202.

The new requirements for E/M codes using time for an Established Patient Exam are:

99212 History/Exam Straightforward MDM 10-19 minutes

99213 History/Exam Low MDM 20-29 minutes

99214 History/Exam Moderate MDM 30-39 minutes

99215 History/Exam High MDM 40-54 minutes

    • Prolonged service code 99XXX may be used with code 99215
    • Code 99211 may still be used for services not requiring presence of physician

All other guidelines for Hospital, Observation, ER, Nursing Home, Home care etc. will be revised. It is imperative that your practice obtain a 2021 CPT coding book to acquaint providers with these revised guidelines for these services.

Please feel free to call us if we can help with training or billing these services for your practice. We want to ensure you are able to collect on all claims, most offices have a 30% decline ratio for medical billing. We take pride in remitting timely and efficient billing, as well as appeal unpaid claims for potential payment.

Call today  (781) 231-7026 for a FREE CONSULTATION!​