by Marty Kotlar, DC, CPCO, CBCS • 

President of Target Coding • 

#1: New Exam & Re-Exam Documentation Guidelines

Effective January 1, 2021, the CPT code guidelines for evaluation and management (E/M) services relating to new patients and established patients will have significant changes. The most common codes affected will be 99202, 99203, 99212, and 99213. The changes will remove the burden of tallying up key components and instead allow providers to choose E/M levels based on either decision-making or time. CPT code 99201 will be deleted on 01/01/2021.  The time ranges are as follows:

  • 99202: 15-29 minutes
  • 99203: 30-44 minutes
  • 99204: 45-59 minutes
  • 99205: 60-74 minutes
  • 99212: 10-19 minutes
  • 99213: 20-29 minutes
  • 99214: 30-39 minutes
  • 99215: 40-54 minutes

 #2: New Code – 99072

In September of 2020, the AMA released a brand new code, 99072.  This is additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease.

This new code is designed to capture the following practice expense factors such as:

  • time spent pre-screening patients before the visit and checking for symptoms onsite
  • apply and remove PPE
  • perform additional cleaning of the examination/procedure/imaging rooms, equipment, and supplies
  • cleaning supplies, including additional quantities of hand sanitizer and disinfecting wipes, sprays, and cleansers
  • reported only once per in-person patient encounter per provider Tax ID# regardless of the number of services rendered at that encounter
  • keep track of and document the costs to your practice for the PPE, the additional staff time required for taking temperatures, completing questionnaires, etc., costs of additional cleaning supplies/materials required for disinfecting the office, additional staff time required for these procedures, and additional janitorial costs associated with the pandemic
  • Contact health plans to verify coverage prior to billing. Out-of-network providers should be able to collect cash, in-network providers may not be able to charge for this service, here again, check with the carriers prior to billing.

 #3: New Code – 99XXX

Effective January 1, 2021, CPT code 99XXX will be used for “Prolonged” E/M services. Code 99XXX is a prolonged office or other outpatient evaluation and management service(s) (beyond the total time of the primary procedure which has been selected using total time), requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service; each 15 minutes.

The new guidelines that will accompany 99XXX provide the rule that you should not report the code for any time period of smaller than 15 minutes. For instance, 99205 will represent 60-74 minutes in 2021. To report 75-89 minutes, you’ll report 99205 and one unit of 99XXX. Once the total time reaches 90-104 minutes, you’ll report 99205 and two units of 99XXX.

Code 99215 will represent 40-54 minutes in 2021. To report 55-79 minutes, you’ll report 99215 and one unit of 99XXX. Do not report 99XXX for any time unit smaller than 15 minutes. Do not report 99XXX on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416.

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Dr. Marty Kotlar is the President of Target Coding. Over the last 12 years, he has helped hundreds of chiropractors, acupuncturists, physical therapists and massage therapists with compliance as it relates to billing, coding, documentation, Medicare & HIPAA. Dr. Kotlar is certified in compliance, a certified coding specialist, a contributing author to many coding and compliance journals and a guest speaker at many state association conventions. He can be reached at 1-800-270-7044, website – www.TargetCoding.com, email – drkotlar@targetcoding.com.