Reimagining E/M Office Visits for 2021 and Beyond

Posted by Practice Management Institute on Oct 30, 2020 3:17:43 PM
Practice Management Institute

The CPT® Evaluation and Management (E/M) office visit codes (99201-99215) are the most-commonly billed codes in medicine, representing nearly a quarter of Medicare Part B spend annually. Changes to the visit codes for office visits become effective January 2021. They include extensive E/M guideline additions, and revisions.

The American Medical Association’s Director of CPT® Editorial and Regulatory Affairs in the AMA Health Solutions Unit, Zach Hochstetler, walked through these E/M office visit revisions during a Virtual Symposium in September, organized by the Healthcare Administration Alliance. During his session, he said that the anticipated impact this first wave of revisions will have on other areas of E/M will carry on into the future. 

Because these landmark revisions impact nearly every specialty, the AMA led a consensus-driven, open and transparent workgroup process that engaged participants with diverse medical specialty backgrounds. Numerous stakeholders, including the Centers for Medicare & Medicaid Services (CMS), commercial payers and medical specialty societies, took part to achieve the first overhaul of E/M office visit documentation and coding in more than 25 years.  

The AMA’s reimagined approach to office visits and changes to the complete restructuring of outpatient E&M codes and guidelines has been a collaborative process, Hochstetler said.  

“This new approach is a significant step towards modernizing patient care in the office that both reduces administrative burden for the clinicians and health care providers, as well as creates incentives to provide better patient care. 

Areas of the new E/M updates that providers, coding, and compliance professionals will need to learn about include an understanding of “total time” and time vs. Medical decision-making. Providers need to indicate total time on the date of encounter, not just face-to-face, he said. 


We did continue to use the CMS Table of Risk as the foundation to create the level of medical decision-making table,” he said"That table is embedded directly within the CPT code set for the first time, so that now there is consistency across what CMS has proposed to accept which is the entire code set that we’ve proposed and then within CPT we’re now working with commercial payers to adopt as well. 

The work group also used CMS contractor and audit tools to try to minimize the issues that people would have with the new system. 

As the health care ecosystem prepares for deployment of these changes on Jan. 1, 2021, provider offices will need training and clarification to eliminate gray areas. The AMA continues to lead the charge on education and implementation so that the positive effects can be felt immediately, and the anticipated impact this first wave of revisions will have on other areas of E/M will carry on into the future. 

Get a first-hand look into the AMA’s visionary and collaborative process of reshaping E/M office visits. Listen to Hochstetler’s session available online for a limited time for an overview of the E/M office visit revisions, including the elimination of 99201. 

Topics: E/M coding

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