![]() ![]() When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter.ĩ9205 - Office or other outpatient visit for the evaluation and management of a new patient, which requires medically appropriate history and/or examination and high level medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter.ĩ9204 - Office or other outpatient visit for the evaluation and management of a new patient, which requires medically appropriate history and/or examination and moderate level medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.ĩ9203 - Office or other outpatient visit for the evaluation and management of a new patient, which requires medically appropriate history and/or examination and low level medical decision making. The following are the 2021 outpatient/office E&M CPT definitions:ĩ9202 - Office or other outpatient visit for the evaluation and management of a new patient, which requires medically appropriate history and/or examination and straightforward medical decision making. The joint AMA CPT workgroup on E&M revised the code descriptors to state providers should perform a “medically appropriate history and/or examination”. While the physician’s work in capturing the patient’s pertinent history and performing a relevant physical exam contributes to both the time and MDM, these elements alone should not determine the appropriate code level. Elimination of History and Physical Exam (“H&P”) elements for code selection Accordingly, after soliciting comments surrounding the AMA’s Current Procedural Terminology (“CPT”) Editorial Panel changes in the proposed rule, the 2020 PFS Final Rule now largely aligns with the E&M coding changes laid out by the CPT Editorial Panel as follows:ġ. Office and Other Outpatient E&M Summary of ChangesĬMS believes that the revised office/outpatient E&M guidelines issued by the AMA accomplished greater burden reduction than the initial CMS policies finalized for calendar year 2021 as presented in the 2019 PFS Final Rule. Summary of the differences between the existing and updated 2021 set of guidelines.Īddition of a new MDM table applicable to codes 99202-99215.Īddition of guidelines for reporting time when more than one practitioner performs distinct parts of the E&M service. Guidelines for office or other outpatient E&M services, outlining the new reporting guidance for E&M codes 99202-99215. Guidelines for observation, inpatient, consultations, emergency department, nursing facility, domiciliary, rest home, custodial care, and home E&M services. Accordingly, the AMA plans to restructure the current E&M guidelines into three distinct sections: Guidelines for observation, inpatient, consultations, emergency department, nursing facility, domiciliary, rest home, custodial care, and home E&M services will not change. E&M Guideline Changes per CPT Editorial Panel An overview of the significant changes is highlighted below. The AMA 2021 code set release will contain all new definitions, including new time ranges and level of Medical Decision Making (“MDM”) Table, which is similar to the Marshfield Clinic E&M scoring tool currently used by most payers. These changes put patients over paperwork by focusing on reducing the administrative burden of documentation and coding, thereby aligning with CMS changes. The proposed changes were issued in 2018 however, the most significant changes will not be implemented until January 1, 2021.Īlmost one year after CMS issued Physician Fee Schedule (“PFS”) Final Rule 2019, the American Medical Association (“AMA”) released its “E&M Office or Other Outpatient and Prolonged Services Code and Guideline Changes”, which will also be enacted effective January 1, 2021. To resuscitate what was often considered an ailing system, the Centers for Medicare and Medicaid Services (“CMS”) enacted substantial changes to physician office and outpatient Evaluation and Management (“E&M”) codes, documentation standards and payment methodologies. ![]()
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