In this blog series we are going to do a deep dive into the 2021 E/M Changes. During the series I will be referring to the official guidelines from the AMA. Click the link below to download a copy.
https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf
In today’s post I am going to address two common misconceptions about the changes.
MYTH ONE – All EM Codes Are Changing
This is not true. The 2021 E/M changes only affect the office visit codes 99201-99215 and prolonged services codes 99354, 99355, 99356, 99XXX. Don’t worry we are going to explain that crazy 99XXX code in a later blog post.
MYTH TWO – Providers will no longer have to document history or exam.
You may have heard that you will no longer have to document a history or exam. This is not true. The guidelines do not say this at all. Instead, they empower you to perform and document histories and exams that you feel are relevant patient’s care. The exciting news is you will not use history or exam to level your service. Finally, you will have freedom from those pesky bullets.
Another interesting change is that code 99201 will go away. This was a small but brilliant move on the part of the AMA. It allows the levels to line up perfectly based on MDM. In 2021 an office level 2 will always be straightforward MDM and an office level 5 will always high MDM. Let me illustrate this for you.
Notice that currently we have two straightforward new patient office visits. The difference between these two comes down to history and exam. But since history and exam will no longer be used to determine your level of service, we no longer need a 99201.
| NEW OFFICE VISIT CODING | |||
| New Pt | MDM Level | Est Pt | MDM Level |
| 99201 | Straightforward | 99211 | Nurse visit |
| 99202 | Straightforward | 99212 | Straightforward |
| 99203 | Low | 99213 | Low |
| 99204 | Moderate | 99214 | Moderate |
| 99205 | High | 99215 | High |
| 2021 OFFICE VISIT CODING | |||
| New Pt | MDM Level | Est Pt | MDM Level |
| 99202 | Straightforward | 99212 | Straightforward |
| 99203 | Low | 99213 | Low |
| 99204 | Moderate | 99214 | Moderate |
| 99205 | High | 99215 | High |
In the next post we will dig deep into how time will be used to determine your level of service. I think you will like how time is going to be on your side in 2021.
Angie the Coder (Angela Wood, CPC) has over 25 years of experience in physician compliance, education and reimbursement optimization.
