The documentation guidelines established by the Centers for Medicare & Medicaid Services (CMS) for evaluation and management (E/M) services, established over 22 years ago, are about to get a major overhaul. Between July 2018 and July 2019, the American Medical Association (AMA) and CMS convened specialty societies and other healthcare professionals to simplify and streamline the coding and documentation for E/M office visits. The idea was to make them clinically relevant, and reduce the excessive documentation burden.
So Long, 99201
The AMA’s guidance is based on time or Medical Decision Making only, so it makes sense to delete 99201, as it encompasses straightforward MDM, with the only current variation arising in history and exam. When eliminating history and exam in the scoring process, this variation is eliminated, thereby supporting the idea of deleting 99201. This official code deletion means you will not find it in your codebook after this year.
But while not all E/M services will be impacted by the 2021 E/M changes, the code set that corresponds to ~60% of E/M services submitted will be. Put another way, any provider who treats a patient in an office setting will be impacted when submitting codes 99201-99215.
A Fresh Start
For years, we’ve all been forced to use the same flawed E/M calculations. Take the 1995 E/M guidelines, which we believe to be incredibly vague, or the 1997 guidelines, which we believe to be too inflexible - not to mention they don’t even support every speciality (hello, Podiatry.) Or, the fact that there are still grey areas around History of Present Illness and Medical Decision Making that leave physicians, coders, and auditors confused and prone to inconsistent coding patterns. In fact, around here, we often joke about how if you got 20 coders in a room and asked each one of them the exact same question, you’d get 20 different answers.