Stay on Track for 2021

Academy Tools Keep You Up to Date on E/M Coding Changes

(Editor's Note: Legislation that Congress approved on Monday, Dec. 21, delays implementation of the primary care add-on code, G221, which was scheduled to take effect on Jan. 1. All other anticipated payment, coding and documentation changes for 2021 are expected to go into effect as planned. AAFP staff will be updating resources throughout the Academy website to reflect this change.)

September 17, 2020, 2:26 pm News Staff -- Evaluation and management services are the family physician’s bread and butter. So, it follows that properly documenting and coding for these services is a must.

Thanks to advocacy by the AAFP and other medical specialty organizations, that task should become considerably less onerous come Jan. 1, 2021, when new office visit E/M documentation and coding guidelines take effect. The changes are intended to reduce administrative burden and enable physicians to spend more time caring for patients.

Here’s a brief overview of what you’ll see next year:

five levels of office visit E/M services will be retained for established patients (CPT codes 99211-99215);
the number of levels will be reduced to four for office visit E/M services for new patients (CPT codes 99202-99205);
the definition of applicable time and medical decision-making methodology for all office visit E/M codes will be revised, and performance of history and exam will be required only as medically appropriate;
clinicians will be able to choose the E/M visit level based on either medical decision-making alone or total time; and
a new primary care add-on code will be added. (See Editor's Note above.)

But don’t wait until January to familiarize yourself with the new guidelines; you’re better off starting now. As AAFP News first told you in May, the Academy has developed a multitude of resources to help you learn what you need to know today -- with more to follow.

Story Highlights

Topping the list is the AAFP’s E/M reference card, which you can now pre-order. This handy tool, available in sets that include five desk reference cards and five pocket cards -- all laminated for durability -- puts information about the following topics at your fingertips:

code selection methods;
updated definition and guidelines for calculating total time;
office visit prolonged services;
revised medical decision-making table;
coding scenarios using medical decision-making; and
additional coding guidance on use of modifier -25.

Card orders will start shipping by Jan. 15.

Other resources you’ll find on the Academy’s E/M webpage include checklists for solo and independent practice physicians, as well as for employed physicians, that detail the steps you should be taking in 2020 to prepare for 2021.

A sample training outline for your practice serves as a guide to ensure you and your staff understand the key concepts of CMS’ revised methodology for selecting appropriate CPT codes, as well the documentation changes needed to support those codes.

Two separate resources outline important questions you need to be asking your EHR, billing services and practice management system vendors and the payers with whom your practice contracts to learn about their plans for implementing the new guidance.

And to support the AAFP’s long-standing advocacy efforts to secure uniform adoption of changes across all payers, there’s also a letter template you can send to private payers to encourage them to adopt the same payment policy changes for E/M codes.

Another recently added resource is tailored to employed physicians. Together with the checklist for employed physicians, “2021 Office Visit Evaluation and Management Services: Talking Points for Employed Physicians” aims to equip you with information about the coming revaluation of codes for these services so you can decide whether a reexamination of the terms of your employment contract is in order and get tips for having that conversation with your administrator.

And that’s not all the page has to offer. It also provides a primer on selecting the appropriate E/M codes by total time or medical decision-making that includes details related to each methodology.