Even before the pandemic hit in early 2020, there were changes made to the medical billing system. Fortunately, some of the codes that were implemented help with describing distance medicine. With temporary codes being finalized or canceled for Medicare and Medicaid, as well as how time is counted and billed, best practices change quickly.
Those aren’t the only changes the AMA made in 2019. Some of the decisions they made to change codes reversed previously approved decisions, and they will take effect as of January 2021. Are you prepared for what is ahead in the world of medical billing? Read ahead for some of the most important changes made to the current procedural terminology for 2020 and beyond.
Medicare and Medicaid Changes
The Centers for Medicare and Medicaid Services (CMS) have requested changes to the Medical Coding for a long time that will allow for greater flexibility in coding and access to care. The key changes here are some additional codes to describe time spent on outpatient visits managing chronic care.
Because the American Medical Association (AMA) must review the services and the codes for them, some of the proposed codes were withdrawn due to some concerns about administrative overhead inherent in incorporating temporary G codes GCCC1, GCCC3, and GCCC4 which pertain to the time intervals spent with a patient. They did, however, choose to finalize GCCC2, and is used for non-clinical staff time in the management of chronic care.
Evaluation and Management Changes
As of January 1, 2021, some of the codes that were finalized in 2019 were reversed. These decisions were made in 2020 but were not effective for a period of time to allow providers and their medical facilities to prepare for the change. These are specifically the 99211-99215 codes that allow for the accurate reporting of time spent with a patient.
Payers, including Medicare, must choose whether or not to adopt the changes to these codes. These are specific codes for outpatient time, and there have been no significant changes to observation codes or inpatient codes. Medical coding is consistently changing, however, so there may be changes to these codes in the future.
Current Procedural Terminology Changes
Current Procedural Terminology (abbreviated to CPT) is the list of accepted codes for explaining the services provided by a caregiver to a payer.
The American Medical Association issues the set of CPT codes, and the 2020 set was released in September of 2019. The new set of codes for 2020 contains a total of 394 changes. These changes can be more specifically described as 71 deletions, 75 revisions, and 248 new codes added to the list.
These changes mean that the field of medical billing is ever-evolving and it is important to make sure that the correct codes are being used at all times so that proper payment can be issued upon the completion of treatment.
Telehealth and Distance Medicine Changes
2020 and the beginning of a new global pandemic fundamentally changed the way that many providers had to approach healthcare. A significant number of visits now take place over video or phone calls rather than in face-to-face sessions.
In September of 2019, the AMA added a number of CPT codes that allowed for the use of novel digital tools for healthcare including patient portals. There are six new codes that help to report online and distance medicine visits such as patients who report their own blood pressure by checking it at home, and some that describe digital communications that are provided by a patient (and initiated by that patient) to a physician or other qualified health care provider, and also communications that are provided to a non-physician health care professional.
Some of these codes are, by necessity, used in conjunction with some of the codes for providing support for ongoing chronic care management.
Changes for Opioid and Substance Abuse Codes
The most significant change for the management of opioid and other substance abuse cases is that finalization was made for bundling certain treatments regarding ongoing care for these conditions. Namely, counseling services including psychotherapy, management, and care coordination.
G2086 through G2088 are used to describe office-based treatment and therapy and are dependent upon the length of treatment and the month in which the treatment occurs.
What is not included in these new bundles is Medication-Assisted Therapy, or, MAT for short. Any medication used in the treatment of these conditions would continue its separate billing under either Medicare part B or part D. Any medically necessary toxicology screening likewise would continue to be billed separately under the schedule of fees for clinical laboratory tests (CLFS).
Why You Need Medical Billing Analysts
Regardless of the extent of your medical claim, it is highly recommended to hire a medical billing and reimbursement expert to determine and testify to the reasonable value of medical service. The provider’s location can affect these costs and reimbursements.
Whether you are a plaintiff or a defendant in a case, one of the most important items in Automobile, Personal Injury, and Medical Malpractice cases is the cost of medical bills. Figuring out medical costs can be complicated, and expert guidance is critical to ensuring you have a clear understanding of what is “fair and reasonable” with regards to the finances involved in your medical care.
Medical Billing Analysts offers support services nationwide, with offices in New York, New Jersey, Connecticut, Pennsylvania, Georgia, Florida, Texas, Nevada & California. Medical Billing Analysts represent both defendants and plaintiffs with regard to improper medical billing and coding.
The team of MBA professionals will review the hospital, medical and therapy bills to determine the value of past medical expenses, and based on local CPT codes they can also perform a Cost Projection Analysis of future costs. Through meticulous analysis, we can justify the reasonable cost of services which assists in resolving the case.
Contact Medical Billing Analysts by phone or email at 800-292-1919 or firstname.lastname@example.org. We’re here for you, whether you need an evaluation of a single charge or a complex injury case.