When did the AMA make new rules regarding E/M Guidelines effective?
Jan 1, 2021
What did these changes in 2021 affect?
These changes affected only new outpatient (99201-99205) and established outpatient visits (99211-99215).
Hospital coding, SNF coding, etc are unaffected.
What is a new office patient?
Someone who has not been seen by you or someone in the EXACT same specialty in your group within the past three years.
What is an established office patient?
Someone who has been seen by you or someone in the EXACT same specialty in your group within the past three years.
- You see a new pt with new onset DM2
- You spend 10 minutes prior to the visit, reviewing labs and other records
- You spend 45 minutes with the patient performing a history and exam and educating her about her disease and the various management options available
- You spend an additional 5 minutes after the visit sending prescriptions and ordering labs for the next visit
- The visit required moderate complexity MDM
- 10 + 45 + 5 = 60 minutes
- The visit required moderate complexity MDM
- Here, since billing on time gives you a higher coding, bill for the 99205 level of care.
- Document time spent
- Include a time attestation describing the activities performed
- “I spent a total of 60 minutes today before, during and after the visit reviewing records, educating the patient about her disease and ordering labs and prescriptions.”
How many levels of MDM are there in the 2021 guidelines?
There are four levels
1) Straightforward
2) Low Complexity
3) Moderate Complexity
4) High Complexity
Under 2021 Guidelines, how many elements are required to determine the MDM level?
Just like the 1995 & 1997 E/M Guidelines, only 2 out of 3 elements are needed to determine the MDM level.
Give an example of a straightforward MDM.
Examples would be the common cold or an insect bite. Doesn’t actually require a physical exam. Risk in minimal.
What billing codes correspond to a straightforward MDM?
99202 or 99212
Low level MDM is required for which billing codes?
99203 : Level 3 New office patient
99313 : Level 3 Established office patient
What coding levels correspond to Moderate level MDM?
If you have a patient with moderate level MDM, you can bill
99204 - Level 4 New office patient
99214 - Level 4 Established office patient
What level of MDM is required for Level 5 New office patient (99205) or a Level 5 Established office patient (99215)?
High complexity MDM
