CodingIntel

Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

  • Become a member
  • E/M Changes for 2021
  • Learn More
    • What is CodingIntel?
    • Membership pricing
    • Free resources
      • Can I Get Paid
      • Nicoletti Notes
      • Everyday Coding Q&A
      • Newsletter Archives
      • NEW! Site map
  • Member Resources
    • NEW! Site map
    • Home
    • Articles
    • Coding Guides
    • Quick Reference Sheets
    • Webinars
  • Coding Education
    • Webinars
    • Courses
    • Specialty resources
    • HCC Coding Guide
    • Order print resources
  • My Account
    • Login
    • Logout
    • Manage Account

E/M Changes in 2021 for 99202-99215 | Overview

  • It’s here! New definitions for codes 99202–99215
  • Clinicians can select new and established patient visit based on time or medical decision making (MDM)
  • New guidelines for using time for 99202—99215, and revised definitions for MDM

The American Medical Association (AMA) CPT® panel changed the definitions, and CMS is in agreement with these.

The changes below relate only to new and established patient visits in 2021, codes 99202—99215. These changes are in the 2021 CPT book.

  • Code 99201 is deleted.
  • Clinicians may use either total practitioner time on the date of service or medical decision making to select a code.
  • There will be no required level of history or exam for visits 99202—99215. The level of history and exam is described as “medically appropriate” and is determined by the clinician.
  • Neither history nor exam will be determining factors in selecting the level of service.

“Office or other outpatient services include a medically appropriate history and/or physical examination, when performed. The nature and extent of the history and/or physical examination is determined by the treating physician or other qualified health care professional reporting the service. The care team may collect information and the patient or caregiver may supply information directly (eg, by portal or questionnaire) that is reviewed by the reporting physician or other qualified health care professional. The extent of history and physical examination is not an element in selection of office or other outpatient services.”

  • Time will be defined as total time spent, including non-face-to-face work done on that day, and will no longer require the service to be dominated by counseling.
  • Visits will have a range for time, e.g., 99213 will be 20-29 minutes, 99214 will be 30-39 minutes
  • There will be new definitions within MDM.
  • The MDM calculation will be similar, but not identical, to the current MDM calculation.
  • CPT® is providing numerous definitions to clarify terms in the current guidelines, such as “chronic illness with exacerbation, progression or side effects of treatment,” and “drug therapy requiring intensive monitoring for toxicity.”  When looking at the single page chart for MDM, reference the definitions in your 2021 CPT book.

All other E/M services that are defined by the three key components will continue to use the 1995 and/or 1997 Documentation Guidelines, not just in 2020, but in 2021. The AMA is continuing to work on changes to other codes, but don’t expect them before 2023.

Members, you can read three in-depth articles about the 2021 changes.

Back to blog


Get more tips and coding insights from coding expert Betsy Nicoletti.

Subscribe and receive our FREE monthly newsletter and Everyday Coding Q&A.

Sign up

We will never share your email address. Unsubscribe anytime.

CPT is a registered trademark of the American Medical Association Copyright 2019, American Medical Association All rights reserved.

Relevant Search Terms: AMA revises codes 99202—99215 in 2021; CMS and CPT agree on changes to E/M codes

Last revised January 4, 2021 - Betsy
Tags: Documentation Guidelines

  • About
  • FAQs
  • Terms of Use
  • Privacy Policy
  • Contact

Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

Copyright 2021, CodingIntel
Privacy Policy