Evaluation and Management Codes 2021 – Do I Have to Use the Revised Guidelines?

Evaluation and Management Codes 2021 – Do I Have to Use the Revised Guidelines?

September 17, 2020

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I work with a pain management physician and we don’t see many Medicare patients. This doctor believes the revised 2021 E/M guidelines will not impact our office practice because of our low Medicare volume. Is this correct?

This is not correct! The revised documentation requirements are from CPT – the coding rule. This is the entity that owns and maintains CPT codes. The changes to CPT code descriptors and guidelines were agreed to by CMS. One of the primary goals of the change, other than simplification, is standardization. We know that, currently, commercial payors and CMS have a variety of documentation standards to support a level of E/M service. Beginning on January 1, 2021, CPT has standardized the documentation of the specific level of new and established outpatient visit codes, which should be applicable to all commercial and government payors. Learn more from us in a 3-hour session dedicated to the new 2021 E/M code guidelines changes. Contact Milka at information@karenzupko.com for more information.

*This response is based on the best information available as of 09/17/20.



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