The Coding Corner

Telehealth Coding and Billing Moving Into 2021

We are moving past 2020 and starting a new year on January 1, 2021. There were many areas of challenges that 2020 brought forth for practices and providers. The year had constant movement with payer updates, state and federal rules and regulation changes, and growth with Telehealth services. NEPHO worked to provide practices and providers with the latest updates to ensure coding and billing accuracy. Telehealth got a lot of attention due to COVID 19. Patients across the nation were encouraged to stay home and as a result practices were looking for alternative methods of providing patient care.

Telehealth was still in early phases of development in Massachusetts when the pandemic hit in March of 2020. Practices had to adopt a Telehealth program quickly to ensure patient care continued during the pandemic. NEPHO will continue to support practices with Telehealth services as we move forward into 2021. Telehealth focus in 2021 will include the following areas:

  • Care management for chronic conditions: Remote monitoring devices will be emerging for patients with conditions such as; diabetes, hypertension, and high cholesterol.
  • Provide coaching and support: Helping patient manage chronic health conditions such as weight management and nutrition counseling.
  • Screen patients for COVID 19 symptoms: Screening without having a patient come into the office will help minimize disease spread and provide referral as appropriate.
  • Offer physical and occupational therapy: This approach will help support better access to care for optimal health results.
  • Case management access: Support case management efforts for patients who have difficulty accessing care (patient that live in rural areas, older adults, and patients with limited mobility).
  • Inpatient stay follow-up: Providers can follow-up in a timely manner with patients after a hospitalization.
  • Support advance care planning and counseling: Providers can help to deliver advance care planning and counseling to patients, caregivers, and family members when a life-threatening event or medical crisis occurs.
  • Non-emergent care to long-term care patients: Supporting non-emergent care to residents in long-term care facilities as needed.

Telehealth will have coding and billing updates effective January 1, 2021. These updates will support the new Evaluation and Management (E/M) changes for outpatient/clinic services. Practices and providers need to be aware of these updates to ensure documentation requirements are being met. Updates include the following:

  • American Medical Association released the new set of E/M coding guidelines that will be effective on January 1, 2021
  • CPT 99201 level of care will be deleted
  • There are new time ranges assigned to each level of service for new and established office patients
  • History (HPI) and Exam will no longer affect the level of care being billed
  • Code selection will be driven by the “time spent” or the MDM
  • There is a new prolong service code payable for each 15 minute increment of prolong service for level 5 visits (high complexity)

There will be NEPHO monthly coding and billing webinars that will provide the most up to date information related to Telehealth coding and billing. Please reach out to Shawn Bromley if you have questions regarding Telehealth services and/or Telehealth coding and billing. shawn.m.bromley@lahey.org or 978-236-1704.

2021 OIG Workplan

The OIG regularly updates their website with additonal Work Plan Items.

Please click here for the most recently added Work Plan items