AMA CPT® Assistant - 2020 Issue 5 (May)
E/M Office or Other Outpatient Guidelines and Code Revisions for 2021: MDM—Part 1 (May 2020)
May 2020 pages 3-8 E/M Office or Other Outpatient Guidelines and Code Revisions for 2021: MDM—Part 1 For Current Procedural Terminology (CPT ® ) 2021, the office or other outpatient visit evaluation and management (E/M) guidelines and code descriptors will be significantly revised. The provided information is published early to raise awareness of substantial changes to current coding practice. This is the first of two articles that will review the changes in medical decision making (MDM), including new guidelines and definitions for E/M office or other outpatient visit codes effective January 1, 2021. Note: Throughout this series of articles...
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Article Overview
This premium article explains the first part of the 2021 CPT update for office or other outpatient evaluation and management services, with emphasis on medical decision making. It is intended for coders, auditors, and clinicians who need to understand how the revised framework changes the way outpatient E/M levels are organized and documented. The article discusses the background for the revision, the updated MDM framework, and the types of criteria and definitions that support code selection under the new guidance.
Why This Topic Matters
The 2021 E/M overhaul affected common office and outpatient coding workflows, documentation review, and audit interpretation. Understanding the revised MDM framework helps coding and compliance staff prepare for the transition and align internal education with CPT guidance.
Article Sections
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May 2020 pages 3-8
Publication details and article identification for the CPT Assistant issue. This section introduces the topic and time frame of the guidance.
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Background
Overview of the upcoming CPT 2021 office or other outpatient E/M revisions and the general shift in how code selection is structured. It introduces the role of medical decision making in the revised framework.
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Revision Overview
Summary of the major changes being introduced in the 2021 code set, including updated MDM organization and related guidance. This section frames the broad scope of the outpatient E/M revision.
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MDM Element: Number and Complexity of Problems Addressed at the Encounter
Discussion of one MDM element and the clarifications added for outpatient E/M reporting. The section outlines the kinds of criteria used to distinguish levels within the revised framework.
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Key Concepts and Definitions
Definitions and interpretive guidance for terms used in the revised MDM framework. This section explains how the article characterizes problems, stability, chronicity, and related concepts.
What You Will Learn
- How the 2021 CPT outpatient E/M revisions are organized
- What changes are being introduced to medical decision making guidance
- Which broad criteria categories are used in the revised MDM framework
- How the article defines key concepts used in outpatient E/M documentation and review
Who Should Read This
- Medical coders
- Coding auditors
- Compliance staff
- Physicians and other qualified health care professionals
- Practice administrators
Codes Discussed
Code Ranges Discussed
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