E&M code updates of 2021
Medicare and Medicare Advantage plans are adopting the new E&M codes starting from 01/01/2021. However commercial insurances usually follow CMS and AMA guidelines, they are not required to adopt the new changes.
Key takeaways
- 99201 and 99211 are obsolete for 2021
- ALL E&M codes should be coded based on time spent or MDM (Medical decision making)
Time spent is defined as total time spent, including non-face-to-face (documentation) work done on that day.
Changes in time range
Providers should be conscious in documenting the time spent on each encounter. Example – If a provider sees twenty patients per day spend an average 35 Mins per patient will equals to 11.6 hours which exceeds a typical eight-hour workday and could be remarked as a red flag for a payer unless the provider works 12 hours a day.
The following elements are required for Medical decision making(MDM)
- Number/complexity of the problems during the office visit
- Amount/complexity of data to review and analyze
- Risk of complications, morbidity, and/or mortality of patient management decisions made at the visit, associated with the patient’s problems, diagnostic procedures, treatments.
Prolonged services:
If the time spent by the provider exceeds 75 minutes for a new patient and 55 minutes for an established patient, add-on code 99417 can be used to indicate prolonged services for each 15 minutes with E&M code (99205 or 99215) which pays $30 more for prolonged services.
Facebook
Twitter
LinkedIn