The New Year is officially here and so are the newly revised Evaluation and Management (E&M) documentation guidelines set forth by the American Medical Association (AMA).1
These changes are effective January 1, 2021 and pertain only to evaluation and management services in the office or other outpatient setting:
New Patient (99202-99205) and Established Patient (99212-99215)
Medical Decision Making
Time
Prolonged Services
Code Changes
These are the most important changes:
The history and exam will no longer be used to select the level of code for office outpatient E&M visits. Selection of the code level is based on either the Medical Decision Making (MDM) or the total time personally spent by the reporting practitioner on the date of the encounter.
These changes also apply to telemedicine visits billed using 99202-99215.
Medical Decision Making
MDM includes establishing diagnoses, assessing the status of a condition, and/or selecting a management option.
It is defined by these three elements:
You can find the AMA MDM table here
You can find the Hopkins Tip Sheethere
Time Defined
For coding purposes, time for these services is the total time on the date of service and it includes both the face-to-face and non-face to face time personally spent by the physician and/or other qualified healthcare professional(s). It includes the following activities:
Preparing to see the patient
Obtaining and or reviewing separately obtained history
Performing a medically appropriate examination and/or evaluation
Counseling and educating the patient/family/caregiver
Ordering medications, tests, or procedures
Referring and communicating with other health care professionals (when not separately reported)
Documenting clinical information in the electronic health record
Independently interpreting results (not separately reported) and communicating results to the patient/ family/ caregiver
Care coordination (not separately reported) 2
New Patient
Total Time
Established Patient
Total Time
99201
Code Deleted
99211
Not Applicable
99202
15-29 minutes
99212
10-19 minutes
99203
30-44 minutes
99213
20-29 minutes
99204
45-59 minutes
99214
30-39 minutes
99205
60-74 minutes
99215
40-54 minutes
Prolonged Services
Code 99147 is used to report prolonged total time provided by the physician or other qualified health care professional on the date of the office or other outpatient services (ie.99205, 99215). This code can be used when the level of the outpatient service was selected based on time and it has exceeded the minimum time required to report the highest level of services by 15 minutes.3
Total Duration of New Patient Office or Other Outpatient Services (use with 99205)
Code(s)
Less than 75 minutes (60-74 minutes)
99205
75-89 minutes
99205 x 1 and 99417 x 1
90-104 minutes
99205 x 1 and 99417 x 2
105 minutes or more
99205 x 1 and 99417 x 3 or more for each additional 15 minutes
Total Duration of Established Patient Office or Other Outpatient Services (use with 99215)
Code(s)
Less than 56 minutes (40-54 minutes)
99215
55-69 minutes
99215 x 1 and 99417 x 1
70-84 minutes
99215 x1 and 99417 x 2
85 minutes or more
99215 x 1 and 99417 x3 or more for each additional 15 minutes
