As a reminder, the American Medical Association (AMA) has released guidelines related to the upcoming changes to office visit evaluation and management (E/M) coding which will become effective on January 1, 2021.
It is important to note that the changes effective January 1, 2021 pertain to physician reporting for office visits only and do not include Emergency Department (ED) E/M reporting. While these changes are specific to physician reporting and not outpatient facility reporting, they may impact each facility’s internal guidelines for hospital-based clinic E/M reporting.
HCPCS code G0463, Hospital outpatient clinic visit for assessment and management of a patient, will continue to be reported by hospitals only to represent clinic visits under OPPS for Medicare beneficiaries. This code assignment will not change as Medicare does not recognize CPT codes 99201-99215 for hospital outpatient clinic visits for Medicare beneficiaries. However, it may be necessary for hospitals to review the upcoming changes for hospital reporting of CPT office visit E/M codes for commercial payers.
See the article published in Coding Clinic for HCPCS, Second Quarter 2020 for additional information.