ED Coding & Reimbursement Alert - 2020 Issue 6
Countdown to 2021: Take a Closer Look at the 2021 Changes to Outpatient E/M Times
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Article Overview
This article explains the upcoming 2021 CPT outpatient evaluation and management time methodology changes, including how time is measured, what activities may be counted, and how prolonged services reporting is being revised. It is aimed at coders, billing staff, and clinicians who assign office and outpatient E/M levels and need to understand the broader structure of the new guidance.
Why This Topic Matters
The article helps readers prepare for a major outpatient E/M coding transition that affects time-based level selection and prolonged services reporting. It is relevant for practices updating workflow, documentation, and charge capture for 2021 CPT guidance.
Article Sections
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Change 1: Counseling no Longer Has to Factor Into Time Calculations
Describes the shift in how outpatient E/M time is considered and the broader move away from requiring counseling to dominate the encounter for time-based coding.
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Change 2: Time Will Be Total, Not Typical
Summarizes the move to total time on the date of service and the categories of work that may be considered under the revised guidance.
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Change 3: Times Will Change and Be a Range
Introduces the new time-range structure for outpatient E/M levels and explains that the prior single typical time approach is changing.
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Change 4: Prolonged Services Coding Will Change, Too …
Covers the overhaul to prolonged services reporting for outpatient E/M services and the introduction of a new code for the updated framework.
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… but Prolonged Clinical Staff Services Coding Will Stay the Same
Notes that prolonged clinical staff service reporting remains in place under the new guidance and is not being replaced by the outpatient prolonged services change.
What You Will Learn
- How the 2021 outpatient E/M time framework differs from prior guidance
- Which broad categories of activities may be considered in total time
- How outpatient E/M time ranges are changing
- How prolonged services reporting is being revised for outpatient E/M
- What remains unchanged for prolonged clinical staff services
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Physicians
- Qualified health care professionals
Codes Discussed
Code Ranges Discussed
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