There will be major changes to E&M coding starting in 2021. This will apply to all insurances including Medicare. Over the next few weeks, I will try to update you on these and other changes as well as direct you to webinars that you should review!

The Medicare conversion factor has gone down more than 10% for 2021. This is the number that is multiplied by the RVU’s for a particular procedure or E&M code to determine your reimbursement under Medicare. We will be getting 5-10% less for the procedures that we perform from nail debridement all the way to Charcot reconstruction and ankle surgery. On the other hand, E&M codes are going up. Also, the criteria to reach the higher levels has changed. We no longer need to do ROM of the upper extremity or gynecological exams to reach a 99204 or 99205.  The level of an E&M will be determined by either Decision Making or time.

For more detailed information concerning the changes to the E&M codes, go to APMA.org/Coding and log in. You will be sent to a list of recent webinars. On Dec. 17, there will be a new webinar on documentation of the E&M codes. You may want to sign up for this webinar as this can be good for ethically increasing your revenue. Finally, podiatrists will be able to use the higher level codes.

Medicare has removed the global days for 28820 (amp of toe at MPJ) and 28825 (amp of toe at IPJ). Zero global days BUT RVU’s have gone down 5.82 -> 3.51 (28820) and 5.37 -> 3.41 (28825). If you do 3-4 post op visits (99212) than you can make up the loss.

Look for more updates (59 modifier, 25 modifier, same and similar) in the next few days. In the meantime, members can click to view other important Medicare updates.

Michael