Major Changes Coming to 2021 E/M Coding

Considerable changes are being made to Medicare outpatient evaluation and management (E/M) codes. The transition will take effect on January 1, 2021 and will likely affect physicians across all specialties.

The changes are currently restricted to new and established outpatient visits (CPT codes 99202-99205, 99211-99215) and will impact everyone who assigns codes, manages patient information, or pays claims including physicians, health information managers, coders, payers, health systems, and hospitals. 

Why was modification needed?

Because of advocacy by the Medical Association and other organizations, the Centers for Medicare and Medicaid Services (CMS) adopted a revised E/M documentation methodology proposed by the American Medical Association (AMA). 

The goal of the suggested adjustments is to reduce physician burden by simplifying documentation requirements and administrative responsibilities. By reducing managerial concerns, physicians will have the ability to spend more in-depth, quality time with their patients. 

What are the changes?

There will be various changes to office and outpatient E/M visits. However, the most notable is the removal of the Level 1 new patient visit (99201), a new 15-minute extended services code that can be used with codes 99205 and 99215, and the following modifications of office code selection:

• History and physical exams are no longer elements for code selection
• Physicians can choose to use total time or medical decision making as the basis of their E/M documentation
• Medical decision-making criteria has been revised and clarified
  • Removed ambiguous terms and concepts
  • Defined vague terms
  • Re-established data elements to move away from adding up tasks and instead focusing on how those tasks affect the patient’s care

What can you do to prepare?

• Visit our website to find more resources on the 2021 E/M coding and guideline changes
• Watch our NEW Online E/M Coding Changes for 2021 webinars hosted by Dr. Thomas Weida and Kim Huey and earn CME
• Contact your medical billing company and/or coders to develop a plan for training office staff to ensure a smooth transition at the first of the year
• Connect with your Electronic Health Records (EHR) provider to confirm that your practice’s system will be ready to implement the new coding changes
• Reach out to your payers to negotiate implementing the new E/M rates

With changes this substantial, we encourage you to prepare early. Watch for more information in the coming weeks on our website and email alerts. If you have further questions, please email us at staff@alamedical.org.