Coding Updates

New Evaluation and Management Codes for 2021

Effective January 1, 2021, Evaluation and Management Codes will be changed for office visits only. The goals of this change are to:
  • Decrease administrative burden
  • Decrease the need for audits by expanding key definitions
  • Decrease unnecessary documentation
Medical decision making (MDM) or time will be used to determine the level of E/M. These changes include reducing the number of service levels and elimination of history and physical examination (H&P) as elements of code selection.

The following points describe these changes in greater detail.

  • Reducing the Number of Service Levels: Code 99201 will be deleted. The new code set will include only codes 99202-99205 for new patients and codes 99211-99215 for established patients.

  • Elimination of H&P as Elements of Code Selection: As a best practice, providers should continue to perform clinically relevant H&Ps, but these will NOT influence code selection. Physicians may choose the level of E/M visit based on either medical decision making (MDM) or time.

  • MDM Reporting: Extensive edits were made to the MDM elements for code selection. These changes are summarized in the American Medical Association, CPT E/M Office Revisions Level of Medical Decision Making (MDM) Table, AMA, Peter Hollmann, et al. Evaluation and Management (E/M) Office Visits-2021. Accessible here. Last accessed 12-17-20.

  • Time-Based Reporting: Physicians may choose for each patient whether their code selection will be based on MDM or time. For code selection based on time, the time reported is total time on the date of service. This is total physician/qualified health care professional time on the date of service. Time includes both face-to-face and non-face-to-face time. Time may be used to select a code level whether or not counseling or care coordination is the primary office or other outpatient service (codes 99202-99215). Time can only be used for level selection for other (time-based) E/M services when counseling and care coordination is the primary service (for time-based codes other than 99202-99215). If reporting is based on time, it is recommended that time is documented.

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