During and following a recent audio conference on orthopedic coding, Stephanie Ellis, RN, CPC, president of Ellis Medical Consulting, responded to questions about challenging orthopedic coding issues from participants in the program. The 2021 guidelines aim to correct those inefficiencies and bring E&M coding into the modern era of telemedicine. AMA’s 2020 CPT ® code set included guidelines on using patient history, clinical examination, and medical decision making (MDM) to determine the correct level of E/M codes. Physicians, physician assistants, APRN, other midlevel providers, and coders in orthopedic practices will need to be trained and educated on how to proceed by the time the changes come into effect in 2021. The American Academy of Orthopaedic Surgeons (AAOS) provides education programs for orthopaedic surgeons and allied health professionals, champions and advances the highest quality musculoskeletal care for patients, and is the authoritative source of information on bone and joint conditions, treatments and related issues. Documentation Guideline Evolution Begins “In the CY 2019 PFS final rule we finalized a number of coding, payment, and documentation changes for office/outpatient E/M visits (CPT codes 99201-99215) to reduce administrative burden. The 2021 E/M coding changes should help ensure you're not leaving money on the table, especially when it comes to coding level 4 visits, which is not as straightforward as coding other levels. Chapter 18: Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) e. Coma scale Header codes like Z47 require more digits to indicate the appropriate level of specificity. The new coding guidelines issued by the Centers for Medicare and Medicaid Services (CMS) reduce the documentation burden and increase the levels of payment (work relative value units or wRVUs). 2021 Revised E/M Coding Guidelines: 99202-99215 New Patients Established Patients 99202 99203 99204 99205 +99417* 15-29 minutes 30-44 minutes 45-59 minutes ... (DHHS) provide the following guidelines for coding and reporting using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). Changes only apply to office or other outpatient codes 99202-99215. Find AAOS clinical practice guidelines (CPGs) and up-to-date, evidence-based treatment recommendations on the following orthopaedic topics: Upper Extremity, Lower Extremity, Pediatrics, Tumor, Infection and Military Medicine. Available ON-DEMAND. Here are three tips for coding and billing common orthopedic procedures. The 2021 ACDIS Pocket Guide includes updates to clinical diagnostic standards, the Official Coding Guidelines, ICD-10-CM codes, CMS-HCCs and CDI critical thinking tips! CMS decided to alter the E/M guidelines in 2018 as part of the Patients Over Paperwork Act. The ICD-10-CM Official Guidelines for coding and Reporting FY 2021 (October 1, 2020 – September 30, 2021) have also been updated. On October 1, 2020, the annual update to ICD-10 codes goes into effect. Orthopedic overview: CPT coding for arthroscopic hip and knee procedures . To understand the 2021 E/M coding changes, you need to know the basics of how E/M coding worked previously. 1. Since then, the AMA has been working to create a new set of E/M guidelines that will become effective Jan. 1, 2021. Coding experts detail the impact of evaluation and management (E/M) documentation guideline changes coming in January. It covers procedure-specific sessions on orthopedic coding, help defending your practice from audits, and information to prepare for 2021. Promote proper reimbursement, coding by reviewing clinical indicators for encephalopathy. Learn more with the AMA. 2021 Coding and Reimbursement Guidelines for ... may include orthopedic plates with accompanying washers and nuts. The new code, U07.1, should be reported for confirmed cases and presumptive positive test results. The current E/M coding guidelines have been in effect for more than 25 years—despite the healthcare industry experiencing momentous change. 3 Clarifications for Orthopedic Injection Coding. 15: Examples of SDH Codes • Z55.0 – Illiteracy and low-level literacy • Z59.0 – Homelessness • Z59.1 – Inadequate housing • Z59.4 – Lack of adequate food and safe drinking water 1. Here are five things you should know about the new coding guidelines: 1.