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.

To keep our clients informed, this newsletter has aggregated material from sources that include the AMA and the AAOS:

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:

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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