April 29, 2021

Question:
I work in a Dermatology practice and we see just a few Medicare patients. The physician believes the revised 2021 E/M guidelines will not impact our office practice because of our low Medicare volume. Is this correct?

Answer:
We are so happy you asked this question. This is not correct,  and it is a common misconception. The revised documentation requirements are from CPT. These are the folks that write the codes, not a specific payor.  The changes were essentially agreed to by CMS, and they are changes to the code descriptors and guidelines in CPT.  One of the primary goals of the change other than simplification is standardization.  We know that commercial payors and CMS have traditionally varied in their 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 s (99202 – 99205 & 99212 – 99215) which should be applicable to all commercial and government payors.

*This response is based on the best information available as of 4/29/21.