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With the new year already upon us, many healthcare professionals are looking forward to a plethora of changes that 2021 is anticipated to bring. The mass vaccination of the global population against COVID-19; advancements in the field of remote patient monitoring; more funding for treatments such as immunotherapy and gene editing, and more are all undoubtedly on this year’s docket.

The administrative side of healthcare is not without its own New Year’s resolutions, though! The American Medical Association has published an update to the Current Procedural Terminology (CPT) code set, which includes various additions, edits, and deletions to outpatient Evaluation and Management (E/M) services codes.

All of these medical coding changes are meant to smooth the administrative process and alleviate some of the box-checking burdens that clinicians face. These changes, which went into effect on January 1, will update the CPT code set to align with modern medical technology and procedures, making it easier for everyone to accurately document patient care and E/M service interactions.

Why New Medical Coding Requirements?

The American Medical Association hadn’t published an update of the CPT code set in 25 years, so an update to the set of codes used for outpatient evaluation and management services was long overdue.

These medical coding changes weren’t just implemented to give healthcare professionals a headache. Although there are new codes to learn and old codes that have been edited or deleted, the recent changes to E/M office visit coding are designed to alleviate some of the administrative burden placed on physicians following patient visits. For example, the modifications to E/M office management coding include eliminating patient history and physical exams as components of the code selection process.

To help physicians choose the best patient care, procedural changes to the code set include allowing code level selection based on medical decision-making or total time. Additionally, the AMA has introduced more detail to CPT code descriptors and guidelines to promote payer consistency. Combined, these procedural updates will result in not only less time devoted to administrative work regarding visit documentation but also fewer clerical and payment errors.

Specific Medical Coding Changes to Know Now

In total, the CPT set underwent 329 changes, which includes 206 new code additions, 69 revisions, and 54 deletions. According to the AMA, 63% of the new codes introduced in the CPT set involve new technologies and the “continued expansion” of the Proprietary Laboratory Analyses (PLA) section of the CPT code set. (The PLA section assigns alphanumeric codes to labs and manufacturers who develop tests for human specimens.)

For medical practitioners who need a quick first look at the medical code changes that took effect on January 1, 2021 (or perhaps those who want to get a head start on their training!), here are two categories of major changes to the CPT code set.

SARS-Cov2 Coding

Predictably, this year’s update to the CPT code set includes language regarding medical testing services that arose from the COVID-19 pandemic. Though some of these codes were approved for immediate use in 2020, they appear in the official publication for 2021.

Continuous Cardiac Monitoring Coding

Although 2020 introduced a great deal of uncertainty and turmoil, the year also included a significant amount of progress in the field of medical technology. Researchers have made tremendous strides in remote patient monitoring, which is reflected in the updated CPT code set that describes continuous cardiac monitoring tools (the previous set of cardiac monitoring codes has been deleted). Specifically, these codes work in an “algorithmic” capacity with the monitoring tool to make it easier for physicians to interpret the collected data.

For a more detailed description of the medical coding changes to the E/M services CPT code set, read the AMA’s official press release.

How will these changes affect my practice?

Any kind of adjustment to your workflow will take some getting used to. So, to ensure a smooth transition, make sure your team is aware of all the changes by coordinating training sessions, either in person or virtually.

For medical billers, the increased detail of the CPT code descriptors and guidelines will be the most relevant change to stay apprised of. While more detail will make it easier to locate the correct code to assign, it will take some time to learn which new keywords have been assigned to which numeric code. Be sure to review these medical coding changes as soon as possible to prevent errors in the billing cycle. If your medical practice has outsourced its medical billing process (or if you’ve made outsourcing medical billing one of your New Year’s resolutions!), be sure your third-party billing service is up-to-date on all the 2021 medical coding changes.

Resources

For medical teams that don’t have the resources or the time to create robust training materials and coordinate training sessions regarding these new coding requirements, the AMA has compiled educational resources to help update office visit codes and guidelines.

• This checklist helps medical administrators and clinicians alike plan for the changes to the Evaluation and Management (E/M) office visit codes.
• These videos detail how to utilize the new changes included in the update of the 2021 E/M office visit CPT codes, such as how to use time to select a code level.
• This guidebook offers a deep dive into all the changes to the 2021 CPT code set. At $50 per copy, having a physical book can be useful for your entire team to read, mark up, and refer back to whenever any of your colleagues need it.

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