Evaluation and Management 2021 Updates
The E&M 2021 changes primarily focused on the documentation and coding guidelines for office and outpatient visits (commonly referred to as E&M codes 99202-99215).
The main goals of these changes were to reduce administrative burden, simplify documentation, and recognize the value of cognitive work performed by healthcare professionals.
Key aspects of the E&M 2021 changes included
The Elimination of history and physical examination requirements as key components for code selection.
The E&M guidelines now allow providers to choose the level of service based on either Medical Decision Making (MDM) or Total time spent on the encounter.
While the documentation of the history and physical examination is still important for patient care, it is not required to determine the appropriate code level but it should be documented in the medical records.
A Revised guidelines for code selection based on medical decision-making (MDM. The MDM now has a greater role in a code selection.
The E&M guidelines provide clear definitions and examples of the components of MDM, such as.,
- Number and complexity of problems addressed,
- Data reviewed and analyzed, and
- Risk of complications or morbidity.
Guidelines for Time Based Code Selection
Expansion of time as a determining factor for code selection. The Providers can now select the code level based on total time spent on the patient encounter, including both face-to-face and non-face-to-face time.
This change benefits providers who spend a significant amount of time on activities like care coordination, reviewing records, and discussing cases with other healthcare professionals.
E&M Updates for 2023
Initially the above said guidelines were introduced to use only for office and outpatient visits and now , effective from Jan 1st 2023, these guidelines will be applicable for across all the level of E&M code selection.
There are some new guidelines Introduced for the specific services,
- Hospital Inpatient and Observation (99221 to 99223, 99231 to 99239)
- Emergency Department Visits (99281 to 99285)
- Consultations codes (99242-99245, 99252-99255)
- Nursing Facility Services codes (99304-99310, 99315, 99316)
- Home or Residence Services codes 99341, 99342, 99344, 99345, 99347-99350
Glimpses of 2023 Changes and Updates
- Deletion of Hospital Observation Services E/M codes 99217-99220
- Revision of Hospital Inpatient and Observation Care Services E/M codes 99221-99223, 99231-99239 and guidelines
- Deletion of Consultations E/M codes 99241 and 99251
- Revision of Consultations E/M codes 99242-99245, 99252-99255 and guidelines
- Revision of Emergency Department Services E/M codes 99281-99285 and guidelines
- Deletion of Nursing Facility Services E/M code 99318
- Revision of Nursing Facility Services E/M codes 99304-99310, 99315, 99316 and guidelines
- Deletion of Domiciliary, Rest Home (eg, Boarding Home), or Custodial Care Services E/M codes 99324-99238, 99334-99337, 99339, 99340
- Deletion of Home or Residence Services E/M code 99343
- Revision of Home or Residence Services E/M codes 99341, 99342, 99344, 99345, 99347-99350 and guidelines
- Deletion of Prolonged Services E/M codes 99354-99357
- Revision of guidelines for Prolonged Services E/M codes 99358, 99359, 99415, 99416
- Revision of Prolonged Services E/M code 99417 and guidelines
- Establishment of Prolonged Services E/M code 993X0 and guidelines
Summary of Hospital inpatient and observation Changes
The Observation Care Discharge Services CPT 99217 has been deleted.
To report observation care discharge services, see 99238, 99239
Initial Observation Care New or Established Patient 99218, 99219, 99220 have been deleted.
- To report initial observation care, new or established patient, see 99221, 99222, 99223
Subsequent Observation Care 99224, 99225, 99226 have been deleted.
- To report subsequent observation care, see 99231, 99232, 99233
Revised CPT Code Description
Admission Service (Initial hospital inpatient or observation)
99221 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making.
When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
99222 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.
When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.
99223 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making.
When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.
Follow up Service (Subsequent hospital inpatient or observation)
99231 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically
appropriate history and/or examination and straightforward or low level of medical decision making.
When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.
99232 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.
When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.
99233 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making.
When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.
Discharge Service - Hospital inpatient or observation
99238 Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter.
99239 more than 30 minutes on the date of the encounter.
For hospital inpatient or observation care including the admission and discharge of the patient on the same date, see 99234, 99235, 99236
*** For 99211 and 99281, the face-to-face services may be performed by clinical staff