September 17, 2020

Question:
I work with a plastic surgeon and we don’t see many Medicare patients. The plastic surgeon believes the revised 2021 E/M guidelines will not impact our office practice because of our low Medicare volume. Is this correct?

Answer:
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 in 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.

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