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CMS implemented the revised Descriptions provided by the AMA and approved the proposal for E/M Outpatient Services Changes. E/M services will be valued based on decision making. Physicians can pick an E/M code depending on the overall time spent on the patient on the date of the appointment or MDM (medical decision making), which is more financially beneficial. The additional bonus is that Medicare proposed the new payment rate and increased the payment for all E/M level.

E/M Changes from January 2021

New changes for Evaluation and Management CPT Codes will go effective as of January 1st, 2021, the beginning of New Year. Healthcare providers and practices need to understand and be prepared to adopt the changes for new extensive addition in E/M codes guidelines.  According to the AMA (American Medical Association), the purpose of the latest revision for E/M Codes is to make the E/M office visit coding more appropriate and easier the reporting.

There was no time to implement new definitions in CPT book 2020, so the rules and code descriptions are unchanged for CPT code 99201-99215 in 2020. The latest update can be found in the 2021 CPT book. These changes reflect a significant shift to decrease the documentation requirements and reduce the complexity of the E/M coding.

E/M Outpatient Services Changes 2021 by AMA and CMS

The following amendments in E/M Outpatient Services that will apply only to new and existing patient visits in 2021, codes 99202—99215.

Changes for New Patient CPT 99202-99205 E/M

Changes for New Patient CPT 99202-99205; new patient codes 99202-99205 no longer need the 3 main components or the traditional face-to-face time in 2021. The CPT code E/M level assignment will depend on the MDM level or overall time spent on the date.

99201 E&M code will be deleted in 2021

CPT 99201 is deleted and will not use in 2021. New patient level 1 E/M code 99201 is not included in the 2021 CPT® code set.  The newly updated code descriptors for the remaining office and outpatient E/M codes use MDM or time to decide code assignment. CPT code 99201 has been removed from E/M code 2021 because 99201 needs a basic MDM, the same as 99202, and it would be unnecessary to have two codes requiring the same MDM standard.

E/M Changes in 2021 for 99202-99215 – key highlights

The following are the major aspects and key highlights of 2021 for 99202-99215 E/M Outpatient Services. E/M coding 2021 guidelines worksheet for CPT 99202-99215.

  • Code 99201 has been removed.
  • CPT codes range 99202-99205 and 99211-99215 only refer to revisions for E/M 2021.
  • To select an E/M code, the clinicians can use either total time on the date of service or MDM (medical decision making).
  • Medical providers no longer need to re-document medical history for patients; only improvements or changes should have been documented since their last evaluation has occurred.
  • For 99202-99215 visits, the level history or exam not required.
  • In deciding the level of service, neither history nor examination will be influencing factors.
  • The Time is defined as overall total spending time, including non-face to face work performed on the day, which will no longer require counselling service to dominate.
  • Each E/M visits will have a unique time-period — for example, the time range for CPT 99202 is 15-29 minutes, and time range for CPT 99205 is 60-74 minutes.
  • 2021 E/M code changes will be applicable for Medicare, Medicaid, and other commercial payers.
  • New definitions included in MDM, which consist of three key elements.
  • For office/outpatient visits in 2021, new elements added in MDMs, and they are related but different from the elements of 2020.
  • A new CPT code 99417 is added to report the “addition of a 15-min prolonged service” with the E/M code. The CPT 99417 can be used with 99205 and 99215.
  • A new HCPCS code, “GPCX1,” has been established to report the visit’s complexity. HCPCS code GPCX1 can be used with any level of
    E/M codes. Its reimbursement rate will be approximately
    $12.

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