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E&M changes to impact office, outpatient coding in 2021 — 5 takeaways


During the February 2019 CPT panel meeting, the American Medical Association discussed changes that would significantly impact office and outpatient evaluation and management coding, ICD-10 Monitor reports.

Five takeaways:

1. The changes will only affect office and outpatient E&M services (CPT 99202 - CPT 99215). There will be a different set of guidelines for all other E&M services. The actions, which aren't final until the 2021 CPT book is published, would take effect Jan. 1, 2021.

2. CPT 99201 (office or other outpatient visits for the evaluation and management of a new patient) will be deleted because of low utilization.

3. History and exam elements won't be factored into office/outpatient E&M code selection. Instead, codes will be chosen based on either total time or level of medical decision-making.

4. The time values linked to each office/outpatient E&M code will reflect the total time spent on the day of the encounter, and will no longer require determining how much of the time was devoted to counseling and coordinating.

5. The following wording used to determine the level of medical decision-making will be changed from:

  • "Number of diagnoses or management options" to "Number and complexity of problems addressed"
  • "Amount and/or complexity of data to be reviewed" to "Amount and/or complexity of data to be reviewed and analyzed"
  • "Risk of complications and/or morbidity or mortality" to "Risk of complications and/or morbidity or mortality of patient management"


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