“So I want to give a little bit of an introduction today as to what’s occurring to at least give you a feeling for it. Certainly this is not going to be what I can fully give you at a full seminar and a, through a consultation, but at least to give you some updates enough to be able to get in, to handle what has changed. So E&M codes, evaluation, and management, or if you will, exam codes are being updated for 2021. So I’m sure you’re all familiar with what a hat we have had of course, in the past, which of course were the standard E&M codes.”

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Hey, welcome everyone. Happy new year.

Glad to have you with me. Thank you to the American Acupuncture Council for giving an opportunity for us to share with you information, putting in billing and really making your practice for the new year. So happy new year to everyone. And of course, year of the ox. And I also will tell you, it’s going to be the year of time. I’m Sam Collins, the coding and billing expert for acupuncture. In fact, you probably see multiple articles from you and acupuncture today and other publications, as well as I’m on the United healthcare committee for coding and reimbursement sitting for acupuncture’s behalf, as well as who for ICD 11. So I have a very vested interest, of course, in your practice, in the thriving of what you do. Well, of course, this year, like all years, there’s always something new and updating, and I’m sure some of you have already noticed there’s been some changes that have happened with E&M (evaluation and management) codes.

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So I want to give a little bit of an introduction today as to what’s occurring to at least give you a feeling for it. Certainly this is not going to be what I can fully give you at a full seminar and a, through a consultation, but at least to give you some updates enough to be able to get in, to handle what has changed. So E&M (evaluation and management) codes, evaluation, and management, or if you will, exam codes are being updated for 2021. So I’m sure you’re all familiar with what a hat we have had of course, in the past, which of course were the standard E&M (evaluation and management) codes. Now, when I say E&M (evaluation and management) always remember that means evaluation and management. So that means evaluation the exam management, the, you know, dealing with the patient, discussing with them. And I’m sure you’re all pretty familiar with these codes in the sense of we have new patient codes. And of course we have established patient codes. What, what these codes are, for course are simply for exams. These codes are no longer going to be there. At least described this way. What they’re doing is trying to make this a lot easier to deal with. So obviously you’ll see these codes. And I think the one thing we all picked up on that was always, there was things like this. You’ll notice here. It says physicians typically spend 10 minutes. Well,

I’m sure you’re all aware that never was the reason

For the code. It was not something based on what’s typical, but what was considered an average and more about what you did on the exam. Now, a quick note, what is not changing is the definition of a new patient or established patient. A new patient of course, is going to remain the same. That’s someone brand new or office or someone you’ve never seen before. Okay. Meaning I’ve never seen them, but it could also be a patient you haven’t seen for three years. So do recall the three year rule when it comes to a new patient, even if it’s a past patient, but they’ve not been to you within three years or more, you may build a new patient again. So that’s the new patient code that’s not changed and established patients not changing either. That’s any exam of a patient that’s existing. Existing means anyone you’ve seen within three years.

So it could even be a new injury, but it also obviously would be a re-exams. So what’s changing. So I kind of chose this Bob Dylan kind of theme times, they are a changing and this is really a dramatic shift and what’s changing. So the bottom line is the codes are changing, but I want everyone to be aware if you attended a seminar with us, the American acupuncture council that I’ve taught, I’ve actually been teaching these changes since 2019. So hope you have a little bit of information if you’ve been there, but let’s keep this in mind. I’m sure most of you are aware. The old way of coding was pretty complicated. There were a lot of guidelines that you can see here. The 1997 documentation guidelines was 50 pages long. And in this guideline, you’ll see all of these things where you had. If you see on the left side here, all these organ systems that you had to have, and then of course it was the number of bullets of what things did you do?

Did you do a range of motion? Did you do palpation? Did you do tongue? And these bullets added up, so you had to have kind of a scoring. So familiarly, if you were billing a nine, nine, two Oh three, you had to do at least two or more organ systems in 12 bullets, which for most people was like, I don’t understand what you’re talking about, or it becomes complicated on the way that acupuncture is, do it. And I’m sure if you’ve been to our seminars again, you’ve seen this guideline as well. That talks about for each code. So notice each code nine, nine two Oh one to two, one two says problem-focused expanded, but you’ll notice it talks about the number of bullets. This is what was complicated. And frankly, this is the reason they’re making a fairly big change with this. The reason why is finally CPT, I think did something to less complicate.

And I won’t say CPT is necessarily trying to complicate, but they’re trying to make it accurate. Well, what they realize they needed to do something with these codes because they really weren’t working for the way doctors examined patients and particularly acupuncturists. And the whole point of this change is to increase time with your patient. Not doing a lot of other works, like doing certain bullets, just to meet the guidelines. It should improve the payment accuracy as well, because it allows you to truly pill a code that’s accurate for what you do, because I’m sure some of you as an acupuncturist are pretty frustrated that often you might spend 30 to 45 minutes with the patient, but yet the exam based on the old guidelines, it might only come out to a two Oh two and you’re thinking, Oh my goodness, I spent 45 minutes. So this update is really reflecting that.

And so what’s happened is these new codes now indicate a focus on time. Oh, let me go back here. And so you’ll notice here. The first thing you’ll notice is nine, nine two Oh one has been eliminated. So you’re never going to use nine, nine two zero one. Again, what we have now for new patients is nine nine two zero two through nine nine two zero nine, excuse me, nine nine two one five. So two zero one has been eliminated. So some people are like, Oh, this is going to be a problem. So take a look here. You’ll notice. Now this code says it’s an office or other outpatient visits. So notice it doesn’t necessarily say exam though. That’s part of it. And it says for the evaluation and management of a new patient, which requires medically appropriate history and examination and a straightforward medical decision-making.

Now you may look at that go, well, what does straight mean? Well, it means it’s fairly minimal, but here’s the best part. Take a look at this. And this is really something excellent for acupuncturists. It says here, when using time for code selection, 15, 29 minutes of total time spent on the date of the encounter. So in other words, the big change for this year is time now becomes a focus that you can use should choose the appropriate code. So if you Ben 15 to 29 minutes, the code would be nine 92. Well, too, if you spend you’ll notice here 30 to 44 minutes, it will be a two Oh three. If you spend 45 to 59 minutes, a 200, and then if you’re going, obviously plus an hour to up to an hour and 14 minutes, it would be a two Oh five. So now what you can do as a provider, start to log the amount of time you’ve taken with the patient.

Cause understand that the time you spend with a patient, not always as doing exam things or palpation, right? If you will, but taking the history gathering. In fact, here’s the really cool part about this. Notice this statement here, it says of total time spent on the date of the encounter. So no longer is it just face to face time. It’s now going to be the entire time. So by example, I bet many of you have a patient fill out a relatively detailed history form. And of course, once they fill that out, you’re going to spend maybe five or 10 minutes reviewing it before you even go in the room with the patient, because you want to see what they said that week and ask more points, questions. Here’s the important part of that. You now you can take the time you did reviewing that before seeing the patient, this is before or after seeing the patient so long as it’s in the same day, it doesn’t have to be face-to-face.

So now I want you to start thinking not only is time important when you document acupuncture, as we’re all aware, but it now also becomes important when doing evaluation. So it’s going to be important if you will to think of it. This is the year of time. I know it’s the year of the ox, but it’s the year of time you’re going to time acupuncture. But now I want you to start to tell me how much time you spent doing any of the activities that are running [inaudible] to your acupuncture visit or exam it could be, or the patient or after if you’re having to review or, you know, probably, uh, consult with another doctor potentially. So you’ll notice all of them have a time value. Now that’s different. So this is a completely new description. That old description is now gone. Now, the other thing that did update a little bit, they did obviously indicate time.

But one thing to note nine, nine two, one, one you’ll notice here does not have a time value. And that’s because that’s considered a value for a non doctor seeing the patient like a staff person, which wouldn’t happen in a Kairos or excuse me, an Accu setting, but maybe in a medical setting, they might have a staff taken a blood pressure. So think of it this way. You’re going to code a nine nine two one one. You’re always going to code. According to time, notice on a re exam of a patient 10 to 19 minutes. Now as a two, one to 20 to 29 minutes is a two, one three. So where I think things are going to be a lot easier for acupuncture. Now, just going to document the time now I will say, let’s be a little careful. If you tell me you spend an hour with every patient, no matter what they have, that’s going to be problematic because now it’s not an issue of what you’re seeing.

It’s a style, but assuming you do more or less, depending on severity, this all makes a lot of sense. And so now you’re simply going to pick the code that’s appropriate. I do believe you’re going to see a lot more potentially two Oh threes and twos, zero fours, based on that timing of that first visit. However, I do think on the re-exams we might be more in the 200 threes and two, one twos, not the two, one fours. It goes on re-exams will you spend more than 30 minutes on the re-exams? I won’t say that is this typical, but not saying not here’s the important part document the time. So here’s, what’s changed the old really based everything on the complexity. And you had to have history of physical exam, medical decision making, and it had to all fit within these guidelines. Well, the new one no longer requires a specific history or exam.

Now that doesn’t mean there isn’t an importance to a history and exam. It just means that’s not going to be the absolute basis for the codes. They’re going to allow you to use the time that you spend with the patient. If you will counseling them to an extent, in addition, they will still allow medical decision making. That’s what MDM stands for here, medical decision-making. So this is where I’m sure some of you have seen this. You can go to a medical doctor and maybe you’re with him or her all of 10 minutes, but they Ville bill a very high value code and you think, Oh my God, how could they build such a code for 10 minutes? Because the medical decision-making being life or death or something that with a great risk of morbidity, mortality may be higher. So there’s still going to be a component of that.

But I think this really helps complementary providers like acupuncturist, better code according to the amount of time and things you need to do with the patient. So to kind of give a synopsis, you’ll notice nine, nine, two Oh two to two Oh five. You’ll notice the total minutes here, but then notice it says medically appropriate. So do keep in mind. If someone comes in with a simple shoulder pain, I doubt that’s ever going to reach a high level, even if you spent an hour. Cause what about that would be high in the sense of risk of morbidity mortality, but what if they have multiple areas? What if there’s low back pain and it’s rated into the stomach? Those all certainly could make a difference. In addition, notice now on the right side as well, it says medically appropriate for the established patients. But notice again, just the time and what it says a straight forward, think of straightforward is something you can almost see it without really even evaluating just based on the patient telling you, but the more complex, the more things we have to do deal with.

So I do want to make an emphasis here. History for an exam is no longer the reason for the code. It could be medical decision-making or time you should do an appropriate history and exam for the patient’s condition. Obviously, would you want to do a full history of a patient with a simple shoulder problem? Probably not. I mean, we don’t need as many of those factors as we did in the past just to qualify, but it would be appropriate necessarily based on the history of the patient. Tell you, so it says here healthcare providers should not interpret this change to mean that the documentation efficient exam is not necessary. A complete medical record of services is rent. Rendered is important for many reasons, such as providing information for quality initiatives, but also making sure that there’s an appropriate amount of information to make the diagnosis that we’re getting.

So although a specific level of history exam will not be a factor for 2021. You still need it for accuracy. Just be careful. Let’s not conflate everything to an hour. So my only concern would be, let’s not put ourselves in a position that if your style indicates an hour, I’m not against that, but that’s not an issue where the necessity based on severity is there. So I know this was a quick and easy to show you the new codes that they’re time-based. But I want to say to all of you, the American acupuncture council is here to help you. And I will say, give us a chance to help you. We have seminars, we have a program called the network where I can become part of your office, what I’d like all of you to do. If you have a moment, take your phone, open up your camera and that little QR code in the left side.

If you click on that, you’re going to get a free 30 days to make me part of your office. Give me a chance to make sure your claims can get paid and help you with these codes. Even better realize we do seminars, but network members get a chance to deal with me one-on-one so that we can go through, well, how do I do this, Sam? What do I need to document? What level to make sure that you’re fully compliant. So if you click there, it gives you a three free 30 days to our service. I would say, give me a chance to send me a couple of bad claims. Send me a couple of claims you weren’t paid on. I will guarantee will always make you more money. And after 30 days, you’re going to happily say, I want to stay part of your program.

As I said, this was going to be quick and easy. And it just to give you an idea, but please take a look for those of you that have our Accu code. Remember, these are all published there as well. So the new codes now are going to be more time to base with an elimination of nine nine two zero one. And of course, no time with nine nine two one one. So document your time. I’m going to say thank you to all of you. And I hope that you get a chance to try the 30 day trial, get ahold of me. Let’s get moving forward. Let’s make 20, 21 the best year ever. Your patients need you. I want to be part of that service with you. So I’m going to say thank you to all of you and I’ll see you next time. This is Sam Collins, the coding and billing expert for the American Acupuncture Council wishing you all the best .

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