In the "
Evaluation and Management Services Guide," which CMS highlighted in a May 7 provider email, the agency has updated its official E/M guidance to put a spotlight on the coming changes. The effort to retool the E/M office visit code set has been a focus for CMS for several years, and all signs point to the new direction going live in a matter of months.
"Effective January 1, 2021, CMS is aligning E/M coding with changes adopted by the American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel for office/outpatient E/M visits," the revised booklet states.
The changes are dramatic and they are expected to significantly alter how physicians and their staff capture the level of care during a patient encounter. The CMS- and AMA-approved guidelines, which will apply to Medicare and private payer claims, remove two elements from the equation when determining an E/M level. The history and exam elements will no longer factor into code level selection in 2021.
Instead, practices will determine the level of an E/M encounter based solely on medical decision-making (MDM) or time. Also, the series of office visit codes will be shortened to nine with the deletion of 99201.
In addition to the documentation changes, E/M payments are on pace for a big raise. The established office visit codes
99212-
99215 are projected to see an average 29% reimbursement increase next year. That and the introduction of an E/M add-on code are expected to
put billions of dollars toward practices that report a lot of E/M encounters, while taking dollars away from other providers.
Apart from the 2020 Medicare physician fee schedule, the updated guidance appears to be the first official nod from CMS that the momentous changes are coming online as scheduled.
You can find additional information about the 2021 changes below.
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