CMS Coding 2021 – AAOA Zoomcast

A brief summary of the CMS Coding 2021 – AAOA Zoomcast Series: Just In Time Content for AAOA Members, Part II. Written by Christie DeMason MD, FAAOA.

Panelists: James Connolly, MD; Ayesha Khalid, MD, MBA; Nalin Patel, MD; Robert Stachler, MD.

Moderator: Jennifer Villwock, MD.

Goal of Panel: Highlight some of the new CMS coding

How Will the Changes Impacting the Practice

• Still too early to know but hopefully positive changes
• Otolaryngologist are likely going to benefit given the level of office complexity/decision making and use of office procedures
• Need to show your decision making thought processes (ex: surgery vs. medical therapy)
  • Less documenting a checklist in the EMR than before
  • Hopefully will be more beneficial
• Now can count time reviewing chart and coordinating care

Changing Templates

• Put in the thought process more and document time spent on all task
  • Then decide if better to code complexity vs. time
  • Important to document as much as possible
    • If review something (order, image, etc.) need to document it
    • Make sure if prescribing or ordering medication to document why you are doing this/what you explained to patient
• May want new smart phase templates for the Assessment&Plan Section   
  • May want to meet with coder before making templates
  • Notes should focus more on risk
    • Ex: risk of missing diagnosis; risk of medications (i.e. prednisone; singular); risk of anaphylaxis with allergy immunotherapy/testing
  • All the things said to the patient should be listed (things that in past often were not documented)
    • Ex: risk of CT and MRI; listing next steps “if CT scan reveals sinus disease and fails medical treatment will need surgery”
• Consider removing parts of template that aren’t as important
  • Doing more focus physical exam (PE) (ex: removing listening to the lungs)
  • Review of System (ROS), PE and past history are less important to document
    • May want to hold off on getting rid of some of these things such as ROS as it can help prove complexity and decision making
  • Hopefully this will help to shift away from the auto-populated charts and to more meaningful information in the charts

Recommendation for Auditing

• Recommend doing audit given coding changes
  • Especially if anticipating large change in billing
  • Coder can help you make sure you actual do make these changes in your billing behaviors and get credit for things you already do
  • Will be important as we don’t know if the payers will actually pay for these changes and if payors will do more auditing because of the new system
  • There are nuances that auditor may pick up on that aren’t specifically in the new coding guidelines
    • Ex: Changes with audiogram and documentation
• Before new changes most did biannually vs. yearly – at least 10 ( usually 10-20) across different providers
  • Can help find areas of under-maximizing revenue too
  • Beneficial to get same company/same auditor each time if possible  
  • Also helpful to do monthly audit on billing/codes and compare to partners, nation and state – ideally want to be similar

Changes Everyone Should Know

• Make sure to add the risks (ex: topical steroid spray, CT scans)
  • Esp. important if patients are able to read their own charts
• Make sure to include in notes/consider templates for medication risk, differential diagnosis, risk of no treatment vs. conservative treatment vs. aggressive management
• Time on all task (pre-charting, looking at past history, writing orders and documenting) can change level of billing  
• Will continue to need to continue to be flexible with new coding system
  • Talk with other doctors and get input
  • Get comfortable with new terminology

For Further Information visit the AAOA website

• Resources available on the website (https://aaoallergy.org/advocacy-updates/changes-to-e-m-codes-beginning-on-january-1st/)
• Prior education offerings on coding from AAOA that could be found in your AAOA Member profile.

View the CMS Coding 2021 Zoomcast.