Beginning January 1, 2021, coding for “Evaluation and Management” (E/M) is changing. These are some of the biggest changes in the past 20 years.

The new guidelines are meant to:

• Reduce administrative burden of documentation and coding.
• Reduce the need for audits, by adding more detail to CPT codes to promote coding consistency.
• Reduce unnecessary documentation that is not needed for patient care.
• Ensure that payment for E/M is resource-based and that there is no direct goal for payment redistribution between specialties.

Some key changes for 2021 are:

• New evaluation and management (E/M) code-selection criteria remove complex counting systems for history, exam and data – that sometimes varied by payer.
• Now, physicians can decide whether to code by the total time OR by medical decision-making related to the visit.
• Medical decision-making is now based on:

1. Number and complexity of problems addressed at the encounter.
2. Amount and/or complexity of data to be reviewed and analyzed.
3. Risk of complications and/or morbidity and mortality of patient management.

• MD activities prior to, during and following a visit can now be included as part of Evaluation and Management (E/M) visit. This includes:
  • Reviewing tests in preparation of a patient visit.
  • Obtaining and/or reviewing separately obtained history.
  • Performing a medically necessary appropriate examination and/or evaluation.
  • Counseling and educating the patient, family or caregiver.
  • Ordering medications, tests or procedures.
• Key coding changes include: CPT: 99201 will be deleted and CPT: 99211 can be billed for non-physician (NP, PA) visits.

For more in-depth information please access these sites:

https://www.aaos.org/aaosnow/2020/apr/managing/managing01/
https://www.ama-assn.org/practice-management/cpt/em-office-visit-changes-track-2021-what-doctors-must-know

We will be providing our Fellow Health Partner clients with ongoing training regarding these changes and are available at any time to answer your questions.

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