As we leave the crazy year of 2020 and enter a fresh 2021, here is a summary of Coding changes taking place that impacts your clinic operations and bottom line:
I. CPT Code 99201 is being deleted effective 1/1/2021
A. Documentation for CPT Codes 99202 through 99205 will be required using criteria of Medical Decision Making OR Time element to determine the level of coding.
o Medicare requirements remain the same for medical decision-making criteria using P.A.R.T. (Pain, Asymmetry/misalignment, ROM decrease, Tissue tone changes) OR diagnostic imaging with documented report of objective findings.
B. CPT 99211 (re-exam) is not being deleted but not used very frequently, and some payers do not pay chiros for this code. You may still bill 99211 when a CT licensed in history-taking and exams performs a re-exam.
C. The 2021 treatment plan model will be the same as 2020:
o Number 1 documentation priority Medicare is looking for: Goals (time or distance element, for example ADLs or specific exercise)
o Number 2 element = duration of care (for example 24 visits)
o Number 3 element = frequency of care (Example – 2X/week for 12 weeks)
II. Changes to ICD-10 codes relevant in chiropractic
1. The following codes have been Added:
A. Arthritis of temporomandibular joint
i. M26.641 right
ii. M26.642 left
iii. M26.643 bilateral
iv. M26.649 unspecified
B. Arthropathy of temporomandibular joint
i. M26.651 right
ii. M26.652 left
iii. M26.653 bilateral
iv. M26.659 unspecified
2. Deleted ICD-10 Codes:
A. M92.50, M92.51, and M92.52 deleted. (Juvenile osteochondrosis). Use M92.8 or M92.9 instead
B. R51 (this headache code deleted). Here are two specific codes added, to use instead:
i. R51.0 Headache with orthostatic component, not elsewhere classified
ii. R51.9 Headache, unspecified
III. Medicare 2021 Reimbursement on covered CMT
Please note a significant reduction in reimbursement across the board for select specialty physicians and surgeons. Here is the chiropractic fee schedule:
Referring back to the exam discussion above, you may want to consider raising your E/M code fees. However, be advised insurances will not reimburse at your full fee, and Medicare as well as most Part C plans as of this writing do not pay for exams performed by Doctors of Chiropractic. These charges are patient responsibility.
Questions? We’re here to help!
Call 920-334-4561 or email lisa@pmaworks.com
Cheers!
~Lisa Barnett
Increasing your collections through better billing and documentation.
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