E&M Coding Changes Among Major CPT Revisions for 2021
By David Doolittle


The American Medical Association (AMA) last week released its 2021 Current Procedural Terminology (CPT) code set, which includes major revisions to office and other outpatient evaluation and management (E&M) services designed to decrease physician documentation requirements. 

The modifications – 329 editorial changes, 206 new codes, 54 deletions, and 69 revisions – will take effect Jan. 1, giving physicians, coders, and practice managers only four months to prepare to implement them. 

The announcement follows the Centers for Medicare & Medicaid Services’ (CMS’) release of its proposed physician fee schedule for 2021, which leaves in place an overhaul of E&M coding for office visits scheduled to go into effect in 2021. CMS last month released the annual draft rule, and TMA is currently preparing formal comments to the agency on it. A final rule is expected to be released later this year. 

Through these changes, AMA and CMS are finally reducing the required additional documentation (also known as “note bloat”) that was required primarily for billing purposes. 

To learn more about the E&M coding changes, tune in to a live TMA webinar scheduled for noon to 1 pm (CT) Wednesday, Oct. 7. 

The webinar will cover topics such as improving your E&M level-of-service selection skills, documenting E&M services properly, and meeting documentation requirements for medical necessity.   

Because of strong advocacy from TMA and organized medicine, CMS did not collapse the office visit levels as it had previously proposed. Instead, Medicare payments will increase for all five office visit levels. While these services will now be paid more appropriately, CMS is required to decrease the conversion factor due to budget neutrality rules. TMA is advocating for federal lawmakers to remove this rule and improve faulty logic in the proposed fee schedule.

TMA advocated for the office visit revisions to allow physicians to spend more quality time with their patients and stress less about administrative burdens. 

AMA’s E&M office visit modifications include:

  • Eliminating history and physical exam as elements for code selection only;
  • Allowing physicians to choose the best patient care by permitting code level selection based on medical decisionmaking or total time; and
  • Promoting payer consistency with more detail added to CPT code descriptors and guidelines. 

In addition, the 2021 CPT codes include new “medical testing services sparked by the public health response to the COVID-19 pandemic,” AMA said. 

TMA continues to monitor all changes to the CPT and CMS codes, including analyzing CMS’ 1,300-plus-page rule proposal

CPT copyright American Medical Association. All rights reserved.

Last Updated On

September 08, 2020

Originally Published On

September 08, 2020

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