April 15, 2021

Question:
I’m still confused about the new E/M guidelines.  Do these new guidelines apply to the consultation codes? Also, I have so many more questions, can you help me?

Answer:
Yes and yes!  First, the new E/M guidelines do NOT apply to the office/outpatient consultation codes, 9924x. So you’ll continue to code those services using the original guidelines where all 3 of the 3 key components – History, Exam, Medical Decision Making – must be met.  Some payors, though not Medicare, still reimburse the consultation codes so providers will have to remember to code those services using the original guidelines.  The new guidelines apply only to the new patient (9920x) and established patient (9921x) codes.

*This response is based on the best information available as of 4/15/21.