For the first time since 1997, Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) have decided to significantly alter documentation requirements for the coding and bill of evaluation and management (E/M) visit codes. These new documentation guidelines will go into effect on January 1, 2021. 

For physicians who bill Medicare and Medicaid, these new documentation guidelines are intended to reduce the administrative burden on outpatient office visits. Yet, while the new guidelines require less documentation, they also come with a flattening of reimbursement rates for all but the most time-intensive and complex visits.

The AMA will be making changes to the 2021 descriptions of these outpatient visit codes to better align the codes with the new documentation requirements.

From these changes, many questions are being asked and many new realities will be created. For example:

  • Does staff need to be retrained?
  • Documentation of medical history is limited to what’s changed and any new complaints that need to be evaluated.
  • For larger organizations, is a headcount reduction warranted?
  • Ancillary staff can pre-populate the medical record with chief complaints and recent medical history instead of wasting valuable physician’s time.
  • Time-based model vs. MDM-based. What works best with your physician(s) and how will it change?
  • No more documentation of medical necessity necessary. Ability to code based solely on time spent with the patient
  • Less likely to be subject to E/M coding audits as there will only be 2 payment levels

The major medical coding and billing impacts to the 2021 E/M codes are:

  • CPT® code 99201 will be deleted.
  • New add-on G code(s) will be released for billing of additional resources associated with primary care
  • Updated CMS Table of Risk will need to be reviewed by those practices that continue to factor in MDM
  • A 15-minute prolonged services codewill be created for 2021 to be used as an add-on code to 99205 and 99215 (previous prolonged services codes were billed in 30-minute increments)

If you are interested in learning more about the 2021 evaluation and management code changes, join the 2021 E/M Changes Webinar on Thursday, March 12th at 1 pm EST. The live webinar will be presented by Monica Grimmett, CPC-I, CRC, CPAR, CFC and is worth 3 AAPC and ARHCP approved CEUs. Join here.