AOA Provides an Update on Upcoming Changes to Coding and Reimbursement Procedures

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ST. LOUIS—The American Optometric Association (AOA), in response to “information disseminated by various individuals and organizations regarding upcoming changes to coding and reimbursement” for evaluation and management services (E/M services), has provided an update about this topic for optometrists. Given the importance of E/M services in patient care, it's critical that all optometrists “are aware of these changes,” the association noted in the post on its website. According to the AOA post, the Centers for Medicare and Medicaid Services (CMS) in 2018 proposed to reduce the payment variation for office/outpatient E/M visit levels by paying a single rate for office/outpatient E/M visit levels 2 through 4 (one rate for established patients and another rate for new patients), while maintaining the payment rate for office/outpatient E/M visit level 5.

The AOA noted that it and other physician organizations spoke out against this proposal, and that the AOA has been engaged in the effort over the past 12 months “to ensure that billing and coding for these foundational services are equitable and appropriate.”

Here's what ODs need to know about the changes, according to AOA. (Or visit the AOA post here.)

• First, there are no changes for 2020, AOA noted.
• ODs should continue to report existing CPT codes for new and established patient visits (99201-99215) and for prolonged face-to-face of­fice visit time (99354-99355).
• Visit level selection remains based upon three key components (history, physical exam and medical decision making [MDM] complexity).
• ODs can choose to use either the 1995 or 1997 E/M documentation guidelines.
• Time may be used for level selection only when over 50 percent of the visit's face-to-face time consists of counseling and/or care coordination, in which case level selection is guided by the "typical times" that accompany the code descriptors.

But AOA noted that “changes are coming in 2021.” CMS has proposed to adopt for 2021 the office visit codes as revised by the CPT Editorial Panel.

CPT 99201 will be deleted in 2021, and ODs can choose the E/M visit level based on either medical decision-making or time. Other changes are planned, AOA said.

The association will host webinar on the E/M code changes at 8 p.m. (ET) Thursday, Jan. 16, to provide further guidance. To register for the webinar, click here.