By:Jacqueline Thelian, CPC, CPC-I, CHCA
Significant changes to the E/M Documentation Guidelines for “outpatient visits” will an important change in 2021.
CMS, the AMA and most physicians agree the cognitive work of physicians and qualified healthcare professionals for E/M office visits is best determined by the time and the level of medical decision making. Therefore, the proposed guidelines for 2021 allow the physician/QHP to select the level of service based upon time or the level of medical decision making.
The AMA has updated the Table of Risk (download below) to include clearer definitions relating to the Number and Complexity of Problems Addressed, the inclusion of Categories regarding Options for the Amount and/or Complexity of Data to be Reviewed and Analyzed as well as straightforward definitions of Risk on the Risk of Complications and/or Morbidity or Mortality of Patient Management.
2021 will also include the deletion of CPT code 99201 Outpatient Office Visit for a New Patient at the lowest level, and a new HCPCS Level II code GPC1X Visit complexity inherit to evaluation and management associated with primary medical care would be added to established office/outpatient CPT® codes. This new add on code will reimburse $15.00.