Sweeping E/M Changes Effective January 1, 2021

The AMA and CMS have released significant changes to outpatient office E/M coding.  The new coding guidelines will be implemented January 1, 2021.  There is no implementation delay expected by CMS.  Therefore, providers have only a few short months to update their documentation templates, test their systems and train their clinical and coding staff on the new guidelines.  

The 2021 E/M outpatient/office guideline changes include:

  • History and exam will no longer contribute to code selection.
  • Coding will be based on medical decision making (MDM) or total time.
  • Significant revisions to MDM instructions
  • Significant revisions to time based instructions
  • 99201 will be deleted.
  • New prolonged service codes.

These changes will require most providers, coder and auditors to operate daily under two significantly different sets of E/M guidelines. It is imperative for providers to start actively preparing now. 

The AMA revised guidelines are located at: https://www.ama-assn.org/practice-management/cpt/cpt-evaluation-and-management

The CMS Final Rule is located at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1715-F

HBE’s team of coding and compliance experts is available to assist you with implementation preparation, design and review of documentation templates, as well as providing customized education and training for your staff. We are also available to provide assistance with conducting risk assessments, internal investigations and policy and procedure development.

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