Medicare and the AMA have published the 2021 E/M Documentation Update which will be implemented January 1st, 2021.
Now that the AMA and CMS has published these changes and 2021 CPT® Books have been shipped, will we end up with a better way to “level” our office visit codes or will this just cause chaos in E/M coding assignments?? And what, specifically are the new CPT ® 2021 AMA E/M changes?
Which E/M Codes are Affected?
The new AMA CPT E/M changes are specific to Office or Other Outpatient Services (99202-99205 and 99211-99215) codes. No other services have been targeted, but there is an expectation more changes will come in the coming years. The new 2021 changes include:
- Deletion of 99201
- New guidelines specific to 99202-99215
- Changes in component scoring for both new and established patient codes (99202-99215)
- Changes to the medical decision-making table
- Changes to the typical times associated with each E/M code (99202-99215)
- Changes to the prolonged services codes with deletions and new add on codes for time
- Importance of the History and Examination portion of the encounter to the specific level of service.
To ensure all parties and payers are involved in understanding the new rules, there is now a different set of coding rules for 99201-99215, CPT established new guidelines (specific to these codes) under their own section header in the Evaluation and Management section of CPT.
Documentation will now focus on the physician’s thought processes on how to take care of patients, instead of the current mandatory standards of click and paste or templated checked box scenarios through Electronic Medical Record systems.
These changes are part CMS’ Patient Over Paperwork Initiative, which aims to reduce the documentation burden on covered health care providers.
Changes will include:
- Guidelines Common to All E/M Services
- Summary of Guideline Differences: Including a table that identifies the differences between the different sets of guidelines
- Revised existing E/M guidelines: Ensuring there isn’t any conflicting information between the different sets of guidelines
- Definitions and Terms have been updated for 2021
- Addition of a new Medical Decision-Making Table specific to 99202-99215
- Guidelines for reporting “Time” when more than one individual performs distinct parts of an E/M service, along with total time on a given date, including coordination of care
Changes in Component Scoring
Although documentation of history and physical examination will still be required to some degree, the amount of history or number of body areas and/or organ systems examined and documented will not be part of the scoring used to determine the overall E/M level of service. Instead, medical decision making (MDM) or total time will be used to make that determination. Additionally, and as always, medical necessity for the level of service must be identifiable within the documentation. There are reports that the Marshall Field Clinic auditing tool will be front and center in this transition.
The impact these 2021 E&M changes will not be delayed and will become effective January 1st, 2021. It is imperative that you train your staff ASAP.
How to Register for our OnDemand Session(s)
Please join us as Terry Fletcher BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM as she presents her multi-part series on these changes.
- Part 1 – E/M Guidelines for 2021 – Documentation Changes
- Part 2 – E/M Guidelines for 2021 – Medicare weighs in – Time vs MDM
- Part 3 – E/M Rules the Final Frontier – How to Level an Encounter and Prolonged services
You can register for all sessions or individual sessions. We recommend you register for all sessions to get the package discount.
Cost: $199 per session or $425 for the full three-session package.
All of these sessions are now available OnDemand.
BS, CPC, CCC, CEMC, SCP-CA, ACS-CA, CCS-P, CCS, CMSCS, CMCS, CMC, QMGC, QMCRC
Ms. Terry Fletcher is a healthcare coding and billing consultant based in Southern California. With over 30-years experience, Ms. Fletcher teaches over 100 specialty coding Seminars, Teleconferences and Webinars every year. You can find her CodeCast™ podcast series, focusing on Physician Coding, Billing, Reimbursement, compliance, and Medical industry revenue opportunities, on iTunes, Stitcher, TuneIn, and Google Play.