AMA CPT® Assistant - 2020 Issue 11 (November)
Preparing for E/M 2021 Changes (November 2020)
November 2020 page 3 Preparing for E/M 2021 Changes New Current Procedural Terminology (CPT®) evaluation and management (E/M) office visit codes and guidelines go into effect on January 1, 2021. Because of the widespread use of these codes and the scope of the changes, the American Medical Association (AMA) initiated early-information distribution and education outreach to facilitate familiarization of these changes in advance of the effective date. This article provides additional information on aspects of the new E/M codes and guidelines based on feedback from the coding community and other stakeholders during this early outreach period. General Overview...
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Article Overview
This article explains the upcoming 2021 revisions to CPT evaluation and management office and other outpatient visit coding. It is aimed at coders, billers, clinicians, and compliance staff who need a neutral overview of the change timing, the scope of affected E/M services, documentation themes, and the general structure of the revised guidance. The article also summarizes questions raised during early outreach about time-based reporting, medical decision making, and prolonged service reporting.
Why This Topic Matters
The 2021 E/M revisions affected one of the most commonly reported service categories, so understanding the scope and structure of the guidance helped teams prepare for implementation and documentation changes.
Article Sections
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General Overview of Changes
Introduces the 2021 E/M update timeline and the broader context for the revisions. It also addresses which service families were included in the initial change set and how the new guidance relates to existing policy frameworks.
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Medical Decision Making (MDM)
Summarizes the revised MDM framework for office and other outpatient services. This section covers the types of clarifications provided in the article, including terminology, data review concepts, and the overall structure of the updated decision-making guidance.
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Time
Explains the updated time-based approach for office and other outpatient visits under the 2021 guidance. It addresses documentation considerations, general reporting concepts, and how time is treated in relation to other services during the encounter.
What You Will Learn
- The overall purpose and scope of the 2021 E/M office visit revisions
- How the updated guidance organizes service selection around time and medical decision making
- What kinds of documentation and reporting topics were highlighted for early implementation planning
- How prolonged service concepts and related questions were addressed at a high level
Who Should Read This
- Medical coders
- Billing staff
- Clinical documentation specialists
- Physicians and other qualified health care professionals
- Compliance and revenue cycle teams
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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