2021 Changes

Question 1

When did the AMA make new rules regarding E/M Guidelines effective?

Answer 1

Jan 1, 2021

Question 2

What did these changes in 2021 affect?

Answer 2

These changes affected only new outpatient (99201-99205) and established outpatient visits (99211-99215).

Hospital coding, SNF coding, etc are unaffected.

Question 3

What is a new office patient?

Answer 3

Someone who has not been seen by you or someone in the EXACT same specialty in your group within the past three years.

Question 4

What is an established office patient?

Answer 4

Someone who has been seen by you or someone in the EXACT same specialty in your group within the past three years.

Question 5

• You see a new pt with new onset DM2
• You spend 10 minutes prior to the visit, reviewing labs and other records
• You spend 45 minutes with the patient performing a history and exam and educating her about her disease and the various management options available
• You spend an additional 5 minutes after the visit sending prescriptions and ordering labs for the next visit
• The visit required moderate complexity MDM

Answer 5

• 10 + 45 + 5 = 60 minutes
• The visit required moderate complexity MDM
• Here, since billing on time gives you a higher coding, bill for the 99205 level of care.
• Document time spent
• Include a time attestation describing the activities performed
• “I spent a total of 60 minutes today before, during and after the visit reviewing records, educating the patient about her disease and ordering labs and prescriptions.”

Question 6

How many levels of MDM are there in the 2021 guidelines?

Answer 6

There are four levels

1) Straightforward
2) Low Complexity
3) Moderate Complexity
4) High Complexity

Question 7

Under 2021 Guidelines, how many elements are required to determine the MDM level?

Answer 7

Just like the 1995 & 1997 E/M Guidelines, only 2 out of 3 elements are needed to determine the MDM level.

Question 8

Give an example of a straightforward MDM.

Answer 8

Examples would be the common cold or an insect bite. Doesn’t actually require a physical exam. Risk in minimal.

Question 9

What billing codes correspond to a straightforward MDM?

Answer 9

99202 or 99212

Question 10

Low level MDM is required for which billing codes?

Answer 10

99203 : Level 3 New office patient

99313 : Level 3 Established office patient

Question 11

What coding levels correspond to Moderate level MDM?

Answer 11

If you have a patient with moderate level MDM, you can bill

99204 - Level 4 New office patient

99214 - Level 4 Established office patient

Question 12

What level of MDM is required for Level 5 New office patient (99205) or a Level 5 Established office patient (99215)?

Answer 12

High complexity MDM