Outpatient Facility Coding Alert - 2020 Issue 2
Countdown to 2021: Know What Stays, What Goes, in the 2021 E/M Shakeup
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Article Overview
This article reviews the planned 2021 changes to office and other outpatient evaluation and management services under the 2020 Medicare Physician Fee Schedule final rule. It is intended for coding professionals, billers, compliance staff, and clinicians who need a broad understanding of the transition, including documentation, time and medical decision-making updates, add-on coding, and payment valuation considerations.
Why This Topic Matters
The 2021 E/M overhaul affected workflow, documentation, code selection, and reimbursement across many practices, so understanding the scope of the changes was important for preparation and systems updates.
Article Sections
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Background
Introduces the policy context for the outpatient E/M changes and summarizes the overall purpose of the rulemaking. It frames the timing and scope of the transition for 2021.
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Industry input
Summarizes the roles of major organizations and stakeholder reactions to the proposed and final changes. It highlights the need for preparation across billing, vendor, and payer systems.
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Here Are the E/M Specifics
Outlines the main categories of changes affecting office and outpatient E/M services. The section focuses on what is being updated for new and established patient visits, documentation, definitions, and add-on reporting.
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Important
Notes a related policy area that is not changing as part of this update and points to future rulemaking. It provides context on adjacent visit groups and broader payment policy.
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Some Specialties May See E/M Pay Cut with New RVUs
Discusses valuation and reimbursement impacts associated with updated relative values. It addresses how different specialties may be affected by the redistribution.
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Reasoning
Explains the agency’s rationale for finalizing the valuation approach and not delaying the changes. It also summarizes comments about timing and future rulemaking.
What You Will Learn
- How the 2021 outpatient E/M update was framed in the Medicare rulemaking process
- Which broad categories of office and outpatient E/M changes were finalized for 2021
- How stakeholder groups and organizations responded to the update
- What types of documentation, time, and valuation topics were discussed
- Why reimbursement impacts were a central concern for different practice types
Who Should Read This
- Medical coders
- Coding auditors
- Compliance professionals
- Practice administrators
- Physicians and other clinicians
- Revenue cycle staff
Codes Discussed
Code Ranges Discussed
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