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What’s Involved in the E/M Coding Changes Coming in 2021

April 1, 2021
April 1, 2021

The Blog post is the next of a series of excerpts from HealthStream’s article, Simplified & Streamlined Healthcare Coding: Coders and Physicians eagerly await E/M coding changes arriving in January 2021.

“This is long overdue, quite honestly,” says Susan Gurzynski-Wells, Senior Product Manager, Reimbursement, at HealthStream. “These two sets of codes [involved] are used for physician office billing, for new and established patients. The code level is assigned depending on the complexity of the visit. Coders/Clinician often use a “Leveling” tool in order to mark how detailed the visit was by reviewing the patient documentation, checking the boxes as they relate to the key components of History, Exam, and MDM. Documentation can now align with patient care and not checking boxes.”

In 2021, code 99201 will be eliminated. Also eliminated is the practice of weighting the history and physical exam as an element of code selection. Instead, guidelines require a medically appropriate history and/or examination. So what does that mean in a real-life setting?

A Real-Life Example of the E/M Coding Change

“If I present to my doctor’s office with an earache,” Gurzynski-Wells says, “or with a cut on my toe and I’m a diabetic, my history and physical will be different and medically appropriate to my presenting condition, but that history and physical exam will not be counted toward the code selection for my visit.”

That means whatever treatment was medically appropriate to the earache was provided, and in the case of the injured toe, the acute underlying condition was noted alongside the treatment—and that’s where the documentation stops.

“What they are trying to do with this elimination is reduce the administrative burden on documentation and coding; with this change, they don’t have to document that they checked my ears, eyes, respiratory system, GI system, and so on. All that is not needed just to treat an earache.”

AN OVERVIEW OF E/M CODING CHANGES

The following changes are only for new and established patient visits beginning in 2021, and around codes 99202 through 99215.

  • Code 99201 will be deleted.
  • Clinicians may use either time or medical decision making to select a code.
  • There will be no required level of history or exam for visits 99202—99215.
  • Time will be defined as total time spent, including non-face-to-face work done on that day, and will no longer require time to be dominated by counseling.
  • Visits will have a range for time: 99213 will be 20-29 minutes, and 99214 will be 30-39 minutes.
  • There will be new definitions within MDM.
  • The MDM calculation will be similar to, but not identical to, the current MDM calculation.
  • CPT® is providing numerous definitions to clarify terms in the current guidelines, such as “chronic illness with exacerbation, progression or side effects of treatment,” and “drug therapy requiring intensive monitoring for toxicity.”
  • All other E/M services that are defined by the three key components will continue to use the 1995 and/or 1997 Documentation Guidelines. (Nicoletti, 2020)

References

Nicoletti, B. (2020, July 28). E/M Changes in 2021 for 99202-99215 | Overview. Retrieved June 25, 2020, from https://codingintel.com/preview-of-eval­uation-and-management-changes-2021/

 

Other installments in this series will include:

  • The Patients Over Paperwork (POP) Initiative
  • The Genesis of the E/M Coding Change
  • Audit Reduction, Another Benefit of E/M Coding Changes

Download the full article, Simplified & Streamlined Healthcare Coding, here.

New HealthStream Coursework Coming for E/M Coders

Starting in September 2020, HealthStream and our partner nThrive will release updated educational and training materials around the E/M coding changes. Learn how HealthStream and nThrive can help with solutions to your coding needs and other revenue cycle challenges.