Updated March 9, 2021
On Nov. 1, 2019, the Centers for Medicare and Medicaid Services (CMS) finalized a historic provision in the 2020 Medicare Physician Fee Schedule Final Rule. This provision includes revisions to the Evaluation and Management (E/M) office visit CPT® codes (99201-99215) code descriptors and documentation standards that directly address the continuing problem of administrative burden for physicians in nearly every specialty, from across the country.
Once the revisions became effective on Jan. 1, 2021, the AMA received a lot of feedback on areas causing confusion. In response, the CPT Editorial Panel’s executive committee accepted technical corrections to the E/M guidelines to provide clarifications in a number of key areas. These revisions were posted March 9, 2021 and are effective as of Jan. 1, 2021.
The Panel approved clarifications include:
- Medical decision making is revised in the following ways:
Clarifying when reporting a test that is considered, but not selected after shared decision making.
Providing a definition of “Analyzed” for reporting tests in the data column.
Clarifying the definition of a “unique” test.
Clarifying what is meant by “discussion” between physicians, and other qualified health care professionals and patients.
Providing a definition of major vs. minor surgery.
- Clarification around which activities are not counted when reporting time as a key criterion for code level selection.
The technical corrections can also be viewed as part of the entire E/M guidelines for 2021 (PDF).
With these landmark changes, as approved by the CPT Editorial Panel, documentation for E/M office visits will now be centered around how physician think and take care of patients and not on mandatory standards that encouraged copy/paste and checking boxes.
Please see the attached link to the entire E/M guidelines. Changes are highlighted in BLUE: E/M guidelines for 2021
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