COVID-19 Medical Coding Updates: January 2021

2021 CPT Medical Coding Updates:

• 99202: Office and other outpatient visits will use this code to evaluate and manage a new patient. The requirement is to have a medically suitable and accurate history or examination and immediate medical determination. 15-29 minutes of total time is spent on the date of the encounter during code selection.
• 99203: Office or other outpatient visits will use this code to evaluate and manage a new patient. The requirement is to have a medically suitable history or examination and a low level of medical decision determination. 30-44 minutes of total time is spent on the date of the encounter during code selection.
• 99204: Office or other outpatient visits will use this code to evaluate and manage a new patient. It must have a medically suitable and accurate history or examination and a moderate level of medical determination. 45-59 minutes of total time is spent on the date of the encounter during code selection.
• 99205: Office or other outpatient visits will use this code to evaluate and manage a new patient. It must have a medically suitable and accurate history or examination and a high level of medical determination. 60-74 minutes of total time is spent on the date of the encounter during code selection.
• 99211: Office or other outpatient visits will utilize this code to evaluate and manage an established patient. It may not require a physician or other qualified healthcare professional to be present as the presenting problems are minimal or less.
• 99212: Office or other outpatient visits will utilize this code to evaluate and manage an established patient that requires a medically suitable and accurate history or examination and straightforward medical determination. 10-19 minutes of total time is spent on the date of the encounter during code selection.
• 99213: Office or other outpatient visits use this code to evaluate and manage an established patient. It is required to have a medically suitable and accurate history or examination and low level of medical determination. 20-29 minutes of total time is spent on the date of the encounter during code selection.
• 99214: Office or other outpatient visits use this code to evaluate and manage an established patient that requires a medically suitable and accurate history or examination and a moderate level of medical determination. 30-39 minutes of total time is spent on the date of the encounter during code selection.
• 99215: Office or other outpatient visits will use this code to evaluate and manage an established patient that requires a medically suitable and accurate history or examination and a high level of medical determination. 40-54 minutes of total time is spent on the date of the encounter during code selection.
• 99354: Prolonged services in the outpatient setting will use this code with a requirement of direct patient contact extended longer than the time of the usual service, first hour, and list separately in addition to code for outpatient Evaluation and Management or psychotherapy service, not including office or other outpatient services (codes 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215)
• 99355: Prolonged services in the outpatient setting requiring direct patient contact beyond the original time of how long the service usually takes will use this code, each additional 30 minutes, and list separately in addition to code for prolonged service.
• 99356: Prolonged service in the inpatient or observation setting will use this code, requiring unit/floor time beyond the usual service, first hour, and list separately in addition to code for inpatient or observation Evaluation and Management service.
• 99415: Prolonged clinical staff service will use this code including service beyond the highest time in the range of total time of the service during an evaluation and management service inside the office or outpatient setting, and direct patient contact with physician supervision, the first hour and list separately additionally to code for outpatient Evaluation and Management service.
• 99416: Prolonged clinical staff service will use this code including the service beyond the highest time in the range of total time of the service during an evaluation and management service inside the office or outpatient setting, direct patient contact with physician supervision, each additional 30 minutes, and list separately in addition to code for prolonged service.
• 99487: Complex chronic care management services will use this code with the requirements of multiple or two chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at risk of death, acute exacerbation, or decompensating, or functional decline, comprehensive care plan established, implemented, revised, or monitored, moderate or high complexity medical determination, first 60 minutes of clinical staff time directed by a physician or other qualified health care professional, each calendar month.
• 99489: Complex chronic care management services will utilize this code requiring multiple or two chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at risk of death, acute exacerbation or decompensating, or functional decline, comprehensive care plan established, implemented, revised, or monitored, moderate or high complexity medical determination, each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, each calendar month and list separately in addition to code for primary procedure.
• 99490: Chronic care management services will utilize this code requiring multiple or two chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at risk of death, acute exacerbation or decompensating, or functional decline, comprehensive care plan established, implemented, revised, or monitored, first 20 minutes of clinical staff time directed by a physician or other qualified health care professional, each calendar month.

Source: AMA