Is Your Practice Ready for the 2021 E/M Changes?

Effective January 1, 2021, new guidelines and code descriptor changes will be enacted for key evaluation and management (E/M) services. The services impacted by these changes are the primary outpatient or office visit codes (99202 – 99215). Code selection for these services will now be based on medical decision-making (MDM) or time, and the guidelines for MDM and time have been redefined.

To help executive directors, operating and financial officers and billing staff in Northern Virginia prepare for these changes, healthcare consultants from Rosen, Sapperstein & Friedlander (RS&F) discussed the new guidelines during a webinar hosted by the Northern Virginia Health Foundation.

Marie Pelino of RS&F noted five key changes that all providers and their practices should take note of:

1. The level of E/M code will be determined by the level of medical decision making only OR total time spent on the encounter on the day of the encounter.

2. The definitions and criteria to determine the level of medical decision making has been rewritten and redefined to go into effect January 1, 2021.

3. When coding E/M services based on time, new time frames are in effect starting January 1, 2021 and includes time spent on direct and indirect patient care activities.

4. A medically appropriate history and physical exam only will be required for all levels of E/M services and will not contribute to the final level of service reported.

5. Code 99201 has been eliminated from CPT effective December 31, 2020 and will no longer be valid.

These changes, Ms. Pelino explained, are intended to help improve productivity by reducing administrative burden and the amount of unnecessary documentation.

Watch the full webinar for a more in-depth explanation of these changes and tips for how your practice can prepare for them.

Download the slides from this webinar.

View the medical decision making table noting 2021 E/M changes. 

Have a specific question about how your practice can prepare for the new E/M changes? Contact Marie Pelino (mpelino@rsandf.com) or Denise Walsh (dwalsh@rsandf.com).