In 2021, the protocol for evaluation and management billing use expanded to allow for the flexibility of choosing a billing code based on either time or medical decision-making. How has this change by CMS affected coding patterns of anesthesiologists?
CMS released its evaluation and management claim breakdown by specialty for 2020, the year before the change, and 2021, the year after the change was made, and there were noticeable changes in coding patterns, according to a Feb. 6 post by medical billing and revenue cycle management company Coronis Health.
The percentage of level 4 evaluation and management visits (codes 99204 and 99214) increased by 8% and 9%, respectively, according to the coding data from 2020 and 2021, the most recent released by CMS.
Coronis said this illustrates that pain providers found it easier to reach a level 4 visit when they did not have to code to the lowest component out of history, exam and medical decision-making, based on the pre-2021 methodology, but rather bill based on the most advantageous of either time or medical decision-making.
The company cautioned providers against billing outside of the typically accepted billing patterns by CMS, to avoid alerting auditors looking for anomalies in coding habits of physicians.