AMA CPT® Assistant - 2020 Issue 11 (November)

Frequently Asked Questions (November 2020)

November 2020 page 12 Frequently Asked Questions Evaluation and Management: Office or Other Outpatient Services Question: In 2021, when determining the complexity of medical decision making (MDM) for level selection for an office visit evaluation and management code (99204, 99205, 99214, 99215), may certain (acute) psychiatric illnesses be considered “acute illness with systemic symptoms”? Answer: Yes, psychiatric disorders are not limited to emotional and behavioral problems. The CPT code set defines “acute illness with systemic symptoms” as “an illness that causes systemic symptoms and has a high risk of morbidity without treatment.” Systemic symptoms, such as changes in...

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CPT® Assistant content is the official source for CPT® coding guidance. It is an instrumental tool when appealing insurance denials and validating coding to auditors. Monthly issues and an extensive archive provide comprehensive guidance on proper CPT® coding for past, present and upcoming code set releases. Archives date back to 1990 for historical use of codes, changes, rationales, coding tips and trends in the industry.

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