New Coding and Documentation Guidance: What You Need to Know in 2021 for Proper Reimbursement
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This article was first published in the Spring 2021 issue of Critical Connections.
Many physicians and advanced practice providers (APPs) who manage critical care patients do so in post-acute care clinics or in the office setting. The inpatient hospital codes (99221-99233), emergency department, consultation (inpatient/outpatient), and other outpatient hospital evaluation and management (E/M) services continue to select the level of service based on the 1995/1997 guidelines that require history, examination, and medical decision-making (MDM), as well as medical necessity. Of course, critical care for adult services (99291-99292) still requires documented time, and the pediatric critical care codes are based on patient age and per diem. For the physician who sees patients in the office or clinic using current procedural terminology (CPT) codes 99202-99215, the guidelines and code descriptions have changed in 2021. A good understanding of what elements are required is imperative for correct coding and proper reimbursement.
Critical Connections, the critical care industry's only newsmagazine, provides information on cutting-edge topics in critical care useful to the entire multiprofessional team.Deborah Grider