The Top 5 Changes to E/M Coding in 2021

Jenny Doloresco, In-Practice Technology Services Consultant Practice Services

For the first time in more than 25 years, coding guidelines for outpatient evaluation and management (E/M coding) services have experienced a major overhaul.

What can practices do to prepare for the E/M Coding changes? 

For medical practices seeking to get the most out of their revenue cycle management and claims submission workflows, proper coding is essential, and that means understanding the changes for 2021. So just what are the top E/M coding changes for 2021?

1. Elimination of History (H) and Physical Exam (PE) as Elements For Code Selection

Under the changes for 2021, providers are no longer required to document a certain level of history exam to satisfy code criteria. Providers now have the discretion to decide for themselves what levels of history and physical examinations are required to treat a patient.

In determining the levels necessary, the care team may collect information and the patient or caregiver may supply information directly (e.g., by portal or questionnaire) that is reviewed by the reporting physician or other qualified healthcare professional.

2. MDM Modification

Another change that is new in 2021 are changes to Medical Decision Making (MDM) code descriptors for 99202–99215. These codes have been revised to include “medically appropriate history and/or examination.” The time designations were also revised in each code.

In 2021, “time” has been redefined as total time instead of face-to-face time. The total time you will use for code selection includes the time spent by the provider on the date of service.

3. Deletion of CPT Code 99201

One important, further alteration to is that CPT Code 99201 is being deleted as part of the E/M coding 2021 changes. This was due to the fact that 99201 and 99202 have the same level of MDM.

4. New add-on Code for Extended Visits (99417) and New Complexity of Service Code (GPC1X)

Another big change to E/M coding in 2021 is the addition of code 99417, to be used for Extended Visits. This code can be used to bill for face-to-face as well as non-face-to-face visits.

Additionally, a new Complexity of Service Code (GPC1X) has been introduced. This Complexity of Service Code is intended to help clinicians report encounters that require more work than described in CPT codes, especially those where special health needs are addressed continually over time.

5. Coding Based on Total Time or Medical Decision Making (MDM)

Under the new guidelines, clinicians now have the option of choosing whether Medical Decision Making (MDM) or Time documentation are the factors used when determining the appropriate E/M code.

Since the 2021 E/M coding changes now allow clinicians the choice of how to bill for a visit, it may be advisable to record time during office visits even if you don’t initially plan to bill based on time. This is because, with the new coding guidelines, time spent with the patient might result in a higher code than using Medical Decision Making (MDM).

While recording time during office visits will be a new concept for many practices, it has become a best practice now that billing on time as opposed to MDM can potentially result in higher reimbursements on some claims.

Medical Advantage Can Help

Medical Advantage’s expert team of practice transformation consultants and billing and coding consultants understand both how crucial it is to code and to bill properly in order to maximize productivity and increase profitability and return on investment for medical practices. Our experts also bring in-practice experience and understand how confusing and headache-inducing understanding and implementing new billing and coding requirements can be.

A comprehensive, up-to-date knowledge of these E/M codes is the best way for physicians to get the most out of their labor. Contact our consultants today to see how we can help your practice stay ahead of E/M coding updates and increase return on investment for your medical practice in 2021.

 

Written in collaboration with Monica Grimmett