CMS has adopted much of the new AMA E/M (evaluation and management) code and guideline changes and they become effective January 1, 2021. These changes affect office encounters and other outpatient visits. Most importantly, the changes could have financial, liability, and contractual ramifications for your clinic.
So what is changing? Things such as the history and physical will no longer be used to determine the level of service. In addition, providers will determine if they prefer to code by the level of medical decision making or by total time. You will also find new prolonged service codes and the elimination of 99201. The AMA’s CPT® Evaluation and Management web page has the full details.
***NOTE: There are no mandates that require your EHR to incorporate these new guidelines into their systems. So, be sure to check with your software vendor to see if their E/M coding tool will be using the new guidelines to determine code suggestions after the first of the year.***
This article is in reference to CMS only. Be sure to check with your other contracted payers for their requirements.
Start learning and preparing for the AMA E/M Code Changes by checking out these links: