2021 has arrived, which means so have changes to the code set. The American Medical Association reported that overall there are 328 editorial changes, including 206 new codes, 54 deletions, and 69 revisions. The AMA has also stated that these changes include the “first major overhaul of office visit and outpatient E/M coding” since the mid-1990’s.

Office visit codes 99201 through 99215 have eliminated the history and physical exam element and enable physicians to select code levels based on medical decision-making or total time spent with the patient. When selected based on time, the code includes both face-to-face and non-face-to-face time spent by the provider.

Activities that may count toward time-related E/M codes include:

• Reviewing tests in preparation for a patient’s visit.
• Counseling or educating a patient, family or caregiver.
• Reporting test results to a patient by phone.
• Ordering medications, tests or procedures.
• “Pajama time” documentation work performed at home.

These changes are expected to be adopted by the centers for Medicare and Medicaid services, effective January 1, 2021.

 

New Patient CPT Codes

99202 – 99205: no longer require the 3 key components or reference typical face-to-face time. Instead, each service includes “a medically appropriate history and/or examination,” and code selection will be based on the level or total time spent on that date. 99201 has been deleted for 2021.

Code	History/Exam	MDM	Total Minutes
99202	Medically appropriate history and/or examination	Straightforward	15-29
99203		Low	30-44
99204		Moderate	45-59
99205		High	60-7

 

Established Patient CPT Codes

99211: Level 1 established patient E/M code 99211 will still be available, but its code descriptor will not include a time reference. This is used if clinical staff members perform the face-to-face visit under the supervision of the physician or other qualified healthcare professional.

99212 – 99215: will follow many of the same guidelines as the new patient codes and differ in the amount of time spent with the patient.

Code	History/Exam	MDM	Total Minutes
99212	Medically appropriate history and/or examination	Straightforward	10-19
99213		Low	20-29
99214		Moderate	30-39
99215		High	40-54

You can read more about changes to E/M codes here: https://www.aapc.com/evaluation-management/em-codes-changes-2021.aspx

 

REMINDER: The updates from 2020 to 2021 have been some of the most extensive in more than 25 years. Because of these extensive changes, is exceedingly important to update your coding books to prevent billing errors or incorrect payment(s); however yearly book updates are suggested.

 

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