Evaluation and management (E/M) coding changes are coming in 2021 – Part 2: What has changed?
Recognizing the 2021 E/M code descriptor revisions
Changes to E/M coding will go into effect on Jan. 1, 2021. This article follows up on part one of our series which introduced the reasoning for these coding changes. We will now focus on key changes for each of the E/M service codes and related code descriptors. Understanding these changes is essential to selecting the correct level of E/M service.
Coding guidance for the 2021 E/M service codes has a clear focus on patient care. By reducing the administrative burden of checking boxes for the History and Examination, the new guidelines allow dermatologists to code for E/M services based on the way they think. These changes promote appropriate coding and payer consistency when audits are performed.
The major changes include:
The level of service can be based on either medical decision making (MDM) or total time spent with the patient on the date of the encounter.
MDM elements
Number and complexity of problems addressed during the encounter
Amount and/or complexity of data to be reviewed and analyzed
Risk of complications and/or morbidity or mortality of patient management
Documentation of medically appropriate history and physical examination will still be required; however, the documentation will not factor into the determination of the overall E/M level of service choice.
Altering the definition of the time element for codes 99202-99215 from typical face-to-face time to the total time spent on the day of the encounter.
Specific times associated with each E/M service code are noted in the table below:
2021 office visit E/M service codes: Time
| New Patient E/M Code | 2021 Total Time | Established Patient E/M Code | 2021 Total Time |
|---|---|---|---|
|
99201 |
Code Deleted |
99211 |
Time Component removed |
|
99202 |
15 – 29 minutes |
99212 |
10 – 19 minutes |
|
99203 |
30 – 44 minutes |
99213 |
20 – 29 minutes |
|
99204 |
45 – 59 minutes |
99214 |
30 – 39 minutes |
|
99205 |
60 – 74 minutes |
99215 |
40 – 54 minutes |
Time = Total time on the date of the encounter
(Before face-to-face, during face-to-face, after face-to-face)
Time
Total time is considered both face-to-face and non-face-to-face time personally spent by the physician and/or non-physician clinician on the day of the encounter
Includes time spent performing activities that require the physician or non-physician clinician but does not include time in activities normally performed by clinical staff
Total time may include counseling and/or coordination of care but is no longer the only determining factor for choosing a time-based level of service
There is no ambiguity to the key elements regarding time. Total time uses increments by giving exact time ranges within the code descriptor. The code selection is the total time on the date of the encounter performing services that can include:
review of tests as dermatologist or non-physician provider prepares to see the patient,
obtaining and/or reviewing separately obtained history,
performing a medically necessary appropriate examination and evaluation and counseling and/or educating the patient/family/caregiver.
The AAD has created a downloadable PDF file to help you view the detailed changes to the 2021 E/M service codes.
The AADA will continue to release intermittent Derm Coding Consult articles and other resources to help dermatology practices implement the operational, infrastructure, and workflow changes that will allow a seamless transition to the new reporting guidelines. You and your staff can prepare with the AADA’s resources this year.
Part 3 of this series will discuss coding examples based on medical decision making and/or time for dermatology specific encounters.
