2021 E&M Changes
2021 E&M Changes
Effective January 1, 2021, the American Medical Association (AMA) brings significant changes in office-based or outpatient E&M visits
As of January 1, 2021, there will be significant changes to the office and outpatient Evaluation and Management (E&M) services (CPT ® codes 99202-99215) for both new and established patients. Practices, physicians, and staff must be aware of the modifications to ensure a successful transition next year and avoid any reimbursement disruption. Their clinical documentation systems (EHR systems) need to be adjusted accordingly.
Reason for E&M changes in 2021
The changes are meant to decrease the administrative burden of documenting and coding on the healthcare providers by,
Decreasing the need for audits through the addition and expansion of key definitions and guidelines
Eliminating unnecessary documentation in the medical record that is not needed for patient care
Ensuring resource-based payment for E/M codes
What are the changes?
New patient level 1 code (99201) will be deleted, reducing the number of levels for new patient office/outpatient E&M visits to four. Established patients retain five levels of coding.
History and physical examination are no longer determining factors in selecting the level of care. Clinically relevant history and examinations must still be documented when necessary
The level of service can be determined based on medical decision making or time criteria
Reduce the documentation insufficiency related denials across all insurances
Medical decision making is determined by three distinct elements that physicians must take into consideration:
Number and complexity of problems addressed
The amount and/or complexity of data to be reviewed and analyzed
Risk of complications and/or morbidity or mortality of patient management
Prolonged Services Code
For a prolonged total time in the Office or Other Outpatient Services, use 99417.
Code 99417 is to be used when the office or other outpatient service has been selected using time alone as the basis, and only after the total time of the highest-level service (i.e., 99205 or 99215) has been exceeded. Fifteen minutes of additional time must have been attained to report a unit of 99417.
Coders should not use 99354 and 99355 for prolonged services with office or outpatient visits.
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