E/M coding changes- effective January 1, 2021

Beginning Jan 1, 2021, there are significant changes coming to E/M (Evaluation and Management) coding.  CMS (Medicare) has simplified the documentation needed to reduce the burden on providers.

 

A few highlights include:

  • CPT 99201 (level 1, new patient) will be deleted
  • Changes to E/M documentation apply to CPT 99202-99205 and 99211-99215 only.
  • A new code for "addition of a 15-min prolonged service" will be added that can be used with 99205 and 99215. (Code will be added here when known)
  • A new HCPCS code GPCX1 "visit complexity" will be created.  Can be used on all levels.  Reimbursement will be around $12
  • H & P as elements for code selection will be eliminated.
  • Providers no longer have to re-document the patients history; only changes that have happened since their last visit.
  • Per AMA, the changes to E/M code selection apply to Medicare, Medicaid and all commercial payers. 
    • Commercial payers are not required to adopt HCPCS code for visit complexity.

 

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There is a great article listing all of the code/guideline changes in this link:

https://www.ama-assn.org/practice-management/cpt/how-2021-em-guidelines-could-ease-physicians-documentation-burdens

In the 5th paragraph, click on the word "description", and the pdf will present.

 

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