Preparing for the 2021 E/M coding changes

December 10, 2020
Area(s) of Interest: Payor Issues and Reimbursement 

With modifications to the outpatient evaluation and management (E/M) coding guidelines set to take effect on January 1, 2021, physician practices must understand and be ready to implement the most impactful overhaul of E/M codes in more than 25 years. According to the American Medical Association (AMA), the upcoming code modifications were designed to make E/M office visit coding and documentation simpler and more flexible, freeing physicians and care teams from clinically irrelevant administrative burdens that led to time-wasting note bloat and box checking.

These E/M office visit modifications include:

  • Eliminating history and physical exam as elements for code selection
  • Permitting code level selection based on medical decision-making or total time
  • Promoting payor consistency with more detail added to CPT code descriptors and guidelines

Physician practices should ensure they have addressed any operational or administrative workflow adjustments so they are out in front of these changes.

AMA offers tools and resources to help practices transition to the new reporting guidelines, including the Office Evaluation and Management (E/M) CPT Code Revisions training module. Also available are step-by-step details to help practices understand the new E/M guidelines, and recommendations for practice managers and coding specialists for ensuring a smooth transition to the new guidelines.

The California Medical Association will be hosting an educational webinar, “E/M Coding Changes 2021,” presented by Mary Jean Sage of Sage Associates on January 12, 2021, at 12:15 p.m. This webinar will focus on the E/M coding changes for 2021 and offer tips to ensure practices are ready for the upcoming coding modifications. This is a free webinar, open to all practices. Click here to register.


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