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The AMA Announces Sweeping Chances to E/M Services

The AMA Announces Sweeping Chances to E/M Services March 12, 2019
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The AMA Announces Sweeping Changes to E/M Services

In a release yesterday, the AMA indicated that they will be significantly revising the E/M section of CPT to be consistent with the E/M changes adopted by CMS in the 2019 Final Medicare Physician Fee Schedule.  The changes which are expected to be included in the 2021 version of CPT include:

  • E/M codes will be selected based on medical decision making or time
  • E/M codes will no longer be selected based on the documented history and exam although, a medically appropriate history and exam will still be required
  • The associated times with each level of E/M will be revised
  • CPT 99201 will be removed
  • The guidelines for determining the level of medical decision making will be revised
  • The guidelines and instructions for E/M services will be revised and divided into 3 categories
    • Guidelines Common to All E/M Services
    • Guidelines for Hospital Observation, Hospital Inpatient, Consultations, Emergency Department, Nursing Facility, Domiciliary, Rest Home or Custodial Care and Home E/M
    • Guidelines for Office or Other Outpatient E/M Services
  • Addition of codes to describe prolonged office E/M services

The AMA announcement is located at

We urge providers to start preparing for these changes in advance.  Both providers and coders will need significant training regarding the new documentation and coding requirements.  Additionally, providers will have to work with their electronic health record providers to update documentation templates as well as system generated coding functions.  Finally, given the adopted reimbursement changes, providers will need to conduct financial analysis to understand the impact of these changes on future cash flow.

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