2021 Evaluation & Management (E/M) Code Changes White Paper-2021 Evaluation & Management (E/M) Code Changes WhitePaper

Pdf Summary

In 2021, there are new E/M (Evaluation and Management) definitions for outpatient clinic visits. These visits can be coded based on either Time or Complexity of Medical Decision Making.<br /><br />For Time-based coding, the total time spent on the date of the encounter is considered, including activities such as reviewing films, looking at labs, counseling the patient/caregiver, documenting in the medical record, coordinating care with other providers, ordering tests and medications, and calling referring providers. The specific codes for Time-based coding are provided, ranging from 15-29 minutes to 60-74 minutes.<br /><br />Complexity of Medical Decision Making (MDM) can also be used to code outpatient services. MDM is determined by three elements: Number and Complexity of Problems Addressed, Amount/Complexity of Data Reviewed, and Risk. Different levels of MDM (straightforward, low, moderate, and high) correspond to specific codes for both new patient visits and return patient visits.<br /><br />The Elements that Define MDM include the number and complexity of problems addressed, the amount/complexity of data reviewed, and the level of risk. The codes for MDM are provided for each level of complexity (straightforward, low, moderate, and high).<br /><br />The amount/complexity of data reviewed is categorized into different levels based on the number or complexity of problems addressed. The level of risk is also categorized into different levels based on the specific risk factors involved.<br /><br />To pick a level of MDM, two out of the three elements (Number and Complexity of Problems Addressed, Amount/Complexity of Data Reviewed, and Risk) must be considered.<br /><br />Overall, the new E/M code changes for 2021 provide options to code outpatient clinic visits based on either Time spent or Complexity of Medical Decision Making. Specific codes are provided for both Time-based coding and MDM-based coding, depending on the level of complexity and the amount/complexity of data reviewed.

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John K. Ratliff, MD, FAANS

Keywords

E/M definitions

outpatient clinic visits

Time-based coding

Complexity of Medical Decision Making

total time spent

specific codes

Number and Complexity of Problems Addressed

Amount/Complexity of Data Reviewed

Risk

E/M code changes