2021 E/M Medical Decision-Making

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If you are a Pro-Fee E/M coder, you already know changes are coming in 2021 for abstracting E/M levels.  I anticipate that production levels will increase.

This change should yield significant financial gains for Independent Contractors who code or audit E/M services and are paid “per piece”.  Hmm, I need to pick up more E/M contracts.  Okay, I need to stay focused!

So, why do I say production levels will increase?  According to the AMA changes for 2021, “The extent of history and physical examination is not an element in selection of office or other outpatient services.”  And, yes, CMS has aligned with the AMA changes.  Coders will only have to focus on the elements of the MDM table to select the level of service (unless the documentation supports coding based upon time).

Providers will still determine the nature and extent of history and/or physical examination, but these two elements will not be considered for determining the level of E/M services reported.

Once coders are comfortable abstracting according to the revised E/M coding guidelines, production should increase.

Although the changes will not go into effect until January 1, 2021, I encourage coders to select a few notes now and practice coding them based upon the revised guidelines for 2021.  This process will help coders feel comfortable with the changes and also provide opportunities for coders to identify deficiencies in documentation to their providers.

It’s the same process we (who were around pre-ICD-10) did to prepare for the transition to ICD-10.

To assist coding professionals in the transition, CPT^® Assistant has provided a series of articles, May 2020 and June 2020 issues that provide expanded definitions, updates on key terms, and clinical examples with rationale.

If you don’t have access to CPT^® Assistant, here’s a link for subscription information.  AMA also offers, E/M Office Visit Compendium 2021 that is a fantastic resource (IMHO).

So, out with the old!  E/M coders, auditors, and educators, changes, and exciting opportunities are coming.  Are you ready to hit the ground running?

 

 

CPT and CPT Assistant is a registered trademark of the American Medical Association

 

 

 

2021 ICD-10-CM Codes Updates Part 2 (Headache) CORRECTION

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One of several significant changes in 2021 ICD-10-CM codes that stands out to me is the update to codes for Headache.  This is an example of why coders should not code from memory.

Prior to October 1st, 2020, we assign ICD-10-CM code R51^®– Headache.  Effective October 1st, the Inclusion term, Facial Pain, NOS is deleted and is included under new code R51.9^® – Headache, Unspecified.

As we know, Inclusion Terms are “List of terms is included under some codes. These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of “other specified” codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive.”

If providers only document facial pain in the impression, the correct code (as of October 1st⁾ will be R51.9^®.  If providers only specify Headache, the correct code is still R51 R51.9^®.

The conditions/codes currently listed as Excludes1 for R51 will be Excludes2 effective October 1st:

Delete Excludes1:

atypical face pain (G50.1) 

migraine and other headache syndromes (G43-G44)

trigeminal neuralgia (G50.0)

 Add Excludes2:

atypical face pain (G50.1)

migraine and other headache syndromes (G43-G44)

trigeminal neuralgia (G50.0)

Here’s the link for the 2021 Tabular Addenda:

 Let’s review, once again, the definitions of Excludes 1 and Excludes2.

“Excludes1 A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.

 Excludes2 A type 2 Excludes note represents “Not included here.” An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.”

After October 1st, if providers document both Headache and Trigeminal neuralgia in the impression, according to ICD-10-CM guidelines, one condition is not necessarily part of the other condition, and it will be appropriate to code both.

The other new code for Headache for 2021 is R51.0 – Headache with orthostatic component, not elsewhere classified, with an Inclusion Term, Headache with positional component, not elsewhere classified.

https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2019-ICD10-Coding-Guidelines-.pdf

The ICD-10 is copyrighted by the World Health Organization (WHO)

Pregnancy and COVID-19 ICD-10-CM

I just listened to a physician being interviewed on a news program and he stated that when a pregnant patient presents with COVID-19, the patient is reported with the pregnancy diagnosis and NOT assigned the COVID-19 diagnosis.

Not quite true.

Please educate your physicians on the guidelines for reporting COVID-19 in pregnancy.

In both, ICD-10-CM Official Coding and Reporting Guidelines April 1, 2020 through September 30, 2020, and 2021 ICD-10-CM Coding Guidelines,  Chapter 15: Pregnancy, Childbirth, and the Puerperium, s. COVID-19 infection in pregnancy, childbirth, and the puerperium, “During pregnancy, childbirth or the puerperium, when COVID-19 is the reason for admission/encounter , code O98.5-, Other viral diseases complicating pregnancy, childbirth and the puerperium, should be sequenced as the principal/first-listed diagnosis, and code U07.1, COVID-19, and the appropriate codes for associated manifestation(s) should be assigned as additional diagnoses. Codes from Chapter 15 always take sequencing priority. If the reason for admission/encounter is unrelated to COVID-19 but the patient tests positive for COVID-19 during the admission/encounter, the appropriate code for the reason for admission/encounter should be sequenced as the principal/first listed diagnosis, and codes O98.5- and U07.1, as well as the appropriate codes for associated COVID-19 manifestations, should be assigned as additional diagnoses.”

So, if the pregnant patient presents for COVID-19, the primary diagnosis is O09.5, and U07.1 is the secondary diagnosis (with of course any associated manifestations coded as additional diagnoses).