There are lot of changes going to happen with Evaluation & Management (E/M) codes in future. CMS has released some of the important changes going to happen with E/M codes from 1st January 2021.
Some of important changes of E/M in 2021
CPT 99201 (Office or other outpatient visit for the evaluation and management of a new patient) will no longer exist as of January 1, 2021.
- Deletion of 99201
- New guidelines specific to 99202-99215
- Changes in component scoring for both new and established patient codes (99202-99215)
- Changes to the medical decision-making table
- Changes to the typical times associated with each E/M code (99202-99215)
Read also: When to use E/M modifiers 25 & 27
The proposed CMS rule further states:
…history and exam would no longer select the level of code selection for office/outpatient E/M visits. Instead, an office/outpatient E/M visit would include a medically appropriate history and exam, when performed. The clinically outdated system for number of body systems/areas reviewed and examined under history and exam would no longer apply, and these components would only be performed when, and to the extent medically necessary and clinically appropriate. Level 1 visits would only describe or include visits performed by clinical staff for established patients.
Their will be elimination of the use of history and/or physical exam to select the correct code level, The exception is that if neither are documented and medical necessity would warrant them being performed and documented, it could trigger additional review.
The new AMA guidelines state that time spent in an E/M service includes all time spent 3 days prior to, or 7 days after it. If a patient calls in to the office to speak with a provider about a medical condition and that telephone conversation results in an appointment for an E/M service that occurs within 3 days of the call, it is not billable as a virtual communication service (G2012, 99441-99443), but rather would be incidental to (or part of) the resulting E/M service. The same would apply if the communication took place within 7 days following the initial E/M service.
We are accustomed to quantifying face-to-face time and time spent counseling and coordinating. However, starting in 2021, the time values associated with each office/outpatient E/M code will indicate the total time spent on the day of the encounter. We will no longer need to determine how much of that time was spent in counseling and coordinating.
Medicare’s new plan is to continue paying distinct rates for each office/outpatient E/M code in 2021. The proposed work RVUs, based on RUC recommendations, are below . In parentheses, you’ll see how the 2021 work RVUs compare to current work RVUs for each code:
- 99202: 0.93 (2019: same)
- 99203: 1.6 (2019: 1.42)
- 99204: 2.6 (2019: 2.43)
- 99205: 3.5 (2019: 3.17)
- 99211: 0.18 (2019: same)
- 99212: 0.7 (2019: 0.48)
- 99213: 1.3 (2019: 0.97)
- 99214: 1.92 (2019: 1.5)
- 99215: 2.8 (2019: 2.11).
References:
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