Get a better understanding of the upcoming E/M coding changes so you can be ready, prevent payment delays, and run your medical practice smoothly.
On our latest webinar, Health Prime’s Medical Coding Team Manager, Neha Bhatnagar, gave an overview of the upcoming changes in the E/M Codes and how physicians and other healthcare professionals can prepare for them.
The CPT (Current Procedural Terminology) codes will only change from 99201 to 99215 on January 1, 2021.
What are these changes?
- History and/or Examination change
Until now, the AMA‘s CPT code guidelines allowed coding based on documentation of 3 components to determine the correct level of E/M codes: patient history, physical examination, and medical decision-making (MDM).
Therefore, the major changes for 2021 are:
- The extent of history and physical examination is separate from the selection of office or other outpatient services.
- The nature and extent of the history and/or physical examination are determined by the treating physician or other qualified healthcare professional reporting the service.
- Office or other outpatient services include a medically appropriate history and/or examination.
- The code set will not include new patient level 1 code 99201
- New patient codes from 99202 to 99205 no longer require the 3 components or reference typical face-to-face time.
- Code selection will be based on the MDM level or total time spent on that date and each service will include a “medically appropriate history and/or examination”.
- The AMA plans to create a new prolonged services add-on code
- E/M code 99211 change
Level 1 established patient E/M code 99211 will still be available, but its code descriptor will not include a time reference.
- E/M codes from 99212 to 99215
Established patient E/M codes from 99212 to 99215 will look similar to the New patient codes. Let’s see this example:
- Appropriate level of E/M services
This level will be based either on the level of medical decision-making as defined for each service or the total time for E/M services performed on the date of the encounter.
- Time documentation
The time documentation will include face-to-face and non-face-to-face time personally spent by the physician and/or other qualified health care professional(s) on the day of the encounter.
It does not include time in activities usually performed by clinical staff.
- Level of service
The level of service will be based on documented medical decision-making (MDM) instead of being based on time.
What’s MDM?
To understand the definition better, let’s see the following infographic:
If you have any questions about these changes, feel free to contact us at [email protected].
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