AMA CPT® Assistant - 2020 Issue 2 (February)
E/M Office Visit Revisions for 2021: An Overview (February 2020)
February 2020 pages 3-6 E/M Office Visit Revisions for 2021: An Overview 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. Due to the widespread use of these codes and the scope of the changes, information is being distributed early to facilitate familiarization in advance of the effective date. This first of a series of articles provides clarification and guidance about the code revisions and guideline changes. Background E/M CPT codes are among the most complex CPT codes to accurately report because of...
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Article Overview
This article explains the scope of the upcoming CPT 2021 changes for office and other outpatient E/M services and why the revisions were introduced. It is intended for coders, billing staff, compliance teams, and clinicians who need to understand the updated structure, documentation framework, and general categories of guidance that will affect code reporting and review processes.
Why This Topic Matters
The article helps readers prepare for a major update to a widely used E/M code family and understand how the revised framework changes the way office and outpatient services are described and supported in the CPT 2021 code set.
Article Sections
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Background
Provides the policy and industry context for the upcoming office and outpatient E/M revisions, including the organizations involved and the broader administrative-simplification effort.
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Revision Overview
Summarizes the major categories of changes affecting the office and outpatient E/M code family and the general scope of the update.
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Revised 2021 E/M Office or Other Outpatient Code Descriptors
Introduces the revised office and outpatient E/M code set structure for new and established patient services and notes the presence of a new prolonged-services-related code concept.
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Creation of Shorter Prolonged Services Add-on Code
Describes the addition of a new add-on service concept tied to prolonged office or outpatient E/M work and its relationship to the revised time framework.
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Code-selection Components Streamlined
Explains the shift in the components used to determine office or outpatient E/M service levels and contrasts the updated framework with the prior approach.
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Revisions to Definition of Time
Covers the broadened time framework for office and outpatient E/M services and the general types of work included in total time.
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Revisions to MDM Elements and Definitions
Outlines the planned refinements to medical decision making concepts and the types of clarifications expected in the updated guidance.
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Table 1. Overview of Major E/M Revisions for CPT 2021: Components for Code Selection for Office or Other Outpatient Services Compared with Other E/M Codes
Presents a comparison of the revised office and outpatient E/M selection framework against other E/M service categories.
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Future Articles
Lists the follow-up topics planned for later installments in the series, including deeper discussion of time, medical decision making, and prolonged services.
What You Will Learn
- The general scope of the CPT 2021 office and outpatient E/M revisions
- How the article frames the transition to the updated documentation and code-selection approach
- What broad categories of guidance are being introduced for time, MDM, and prolonged services
- How the office and outpatient E/M framework differs from other E/M service categories
- What future installments in the series will address
Who Should Read This
- Medical coders
- Billing and reimbursement staff
- Compliance professionals
- Physicians and other qualified health care professionals
- Practice managers
- Revenue cycle teams
Codes Discussed
Code Ranges Discussed
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