CPT 2021 Changes to New and Established Patient Codes Copied

The iKnowMed product team has been planning for anticipated changes to CPT codes beginning on January 1, 2021, pending publication of the CMS Final Rule. These include several changes to New Patient and Established Patient E/M and prolonged visit codes as well as changes to accommodate time-based billing.

The billing screen is being enhanced to make the transition as smooth as possible for physicians starting in version 3.0.19 for visit dates beginning on January 1, 2021. Additionally, with the recent publication of the CMS Final Rule, we are planning an update that will be deployed before the end of the year to complete the necessary enhancements and comply with the CMS Final Rule.

All new codes, descriptions, and E/M time-based billing calculations will be available on the billing screen for visits starting on January 1, 2021.

Changes for visits prior to January 1, 2021:

1. New Select a Code band to break up the screen (see callout 1).

2. Blue band around each code in the selected codes section at the top of the screen to make it easier to distinguish codes when more than one is selected (see callout 2).

   

Changes for visits on or after January 1, 2021:

We have preserved current workflows for users who do not want to use the new time-based features. However, minor design changes were made to the screen, including:

1. Based on the new CPT 2021 E/M codes, providers may bill for total time spent on the date of the encounter using the Total Minutes Spent drop-down, which allows you to choose a time frame and automatically selects the correct E/M Codes and Prolonged Codes for a New Patient or Established Patient visit (see callout 3).

   1. The Total Minutes Spent field is available in version 3.0.19 for AMA’s CPT 2021 codes 99202-99205 for new patient visits and codes 99212-99215 for established patient visits. Prolonged visits will receive the 99417 add-on code.

   2. Additional adjustments in an upcoming patch will incorporate time described in the CMS Final Rule.

      

2. The billing screen will display different codes based on the year of the appointment to accommodate codes that are no longer valid, have had their usage changed in 2021, or have new descriptions.

3. New Prolonged Codes have been assigned for use with Level 5 New (99205) and Established (99215) patient visits, which replace 99354 and 99355.

   1. AMA has designated 99417 each unit representing 15 minutes of prolonged time.

   2. CMS has designated G2212 each unit representing 15 minutes of prolonged time.

4. CMS has also introduced Visit Complexity Code G2211, which is valid with new and established patient E/M codes.

NOTE: Beyond the changes listed above, there are no other changes to codes in the E/M Codes section of the billing screen. Please continue to code the other visit types as you do today.