E&M Coding Changes 2021

E&M Coding Changes 2021

History and Physical Exam Are Eliminated as Elements for Code Selection

• Performing a medically appropriate examination and/or evaluation
• Documenting clinical information in the patient’s chart
• Ordering medications, procedures or tests
• Coordinating care (when not separately reported)
• Referring to or communicating with other healthcare professionals (when not separately reported)
• Preparing for the patient visit
• Obtaining and/or reviewing separately-obtained history
• Counseling and educating the patient, the patient’s family or caregiver
• Independently interpreting results (where not separately reported) and communicating results to the patient, the patient’s family or caregiver

Prolonged Services Coding Changes

Prolonged services codes are typically used when E/M services extend beyond the total time identified with the code level that would otherwise be billed for the primary procedure.

Here are some of the changes that apply to these codes:

• 99417 is new and can be used in conjunction with 99205 or 99215
• These codes apply to face-to-face time and non-face-to-face time
• Less than 15 minutes will not be considered “prolonged”

 The AMA provided the following prolonged services tables as resources for physicians:

Prolonged Service Without Direct Patient Contact