CHICAGO — Major modifications are coming to the coding,  documentation, and payment of evaluation and management (E/M) services for office visits as Medicare has signaled its intention to implement finalized guidelines and payment rates as planned on January 1, 2021. Yesterday’s release of the proposed 2021 Medicare physician payment schedule reconfirmed the designated implementation date announced last November by the Centers for Medicare & Medicaid Services (CMS).

“The AMA appreciates that CMS will implement significant increases to the payment for office visits, based on recommendations on resource costs from the AMA/Specialty Society RVS Update Committee (RUC), said AMA President Susan R. Bailey, M.D. “Unfortunately, these office visit payment increases, and a multitude of other new CMS proposed payment increases, are required by statute to be offset by payment reductions to other services, through an unsustainable reduction of nearly 11% to the Medicare conversion factor. For this reason, the AMA strongly urges Congress to waive Medicare’s budget neutrality requirement for the office visit and other payment increases. Physicians are already experiencing substantial economic hardships due to COVID-19, so these pay cuts could not come at a worse time.”

“Reducing documentation overload and providing physicians more time with patients, not paperwork, was the fundamental purpose of overhauling the E/M office visit guidelines,” said Dr. Bailey “With less than five months until the transition from the old guidelines to the simpler, more flexible guidelines, the AMA is dedicated to helping physician practices get the full benefit of the burden relief the change is designed to bring.”

Between July 2018 and July 2019, the AMA worked with CMS and convened specialty societies and other health professionals to simplify and streamline the coding and documentation for E/M office visits, making them clinically relevant, and reducing excessive administrative burden. Key elements of the E/M office visit overhaul include:

  • Eliminating history and physical exam as elements for code selection. While significant to both visit time and medical decision-making, these elements alone should not determine a visit’s code level.
  • Allowing physicians to choose whether their documentation is based on medical decision-making (MDM) or total time. This builds on the movement to better recognize the work involved in non-face-to-face services like care coordination.
  • Modifying MDM criteria to move away from simply adding up tasks to focus on tasks that affect the management of a patient’s condition.

While CMS recognized the increases in the payment bundles for maternity care and a few other select services, the visits within the surgical global payment bundle remains unchanged. The AMA strongly supports CMS adoption of the office visit changes and continues to urge CMS to incorporate the office visit payment increases into the global surgery packages.

“There is a lot for physician practices to understand before the new E/M office visit guidelines take effect Jan. 1, 2021,” said Dr. Bailey. “The AMA is helping physician practices prepare now for the transition and offers authoritative resources to anticipate the operational, infrastructural and administrative workflow adjustments that will result from the planned transition.”

The AMA has developed an extensive online library of easy to use resources, which include the following titles:

CPT Evaluation and Management
A historical overview and summary of the E/M coding revision for office visits.

10 Tips to Prepare your Practice for E/M Office Visit Changes
A checklist with linked resources to guide physician practices for a smooth transition to the simpler and more flexible E/M office visit documentation and coding guidelines.

Office Evaluation and Management (E/M) CPT Code Revisions
An educational module providing an overview of the new E/M coding revisions for office visits that will help physicians and practice staff understand how these foundational changes will affect their work and reduce their documentation burden.

Revisions to the CPT E/M Office Visits: New Ways to Report Using Time
An educational module providing detailed information on how the new E/M coding revisions for office visits have clarified and simplified the time component of code selection to reduce administrative burden.

Revisions to the CPT E/M Office Visits: New Ways to Report Using Medical Decision Making (MDM)
An educational module providing detailed information on how the new E/M coding revision for office visits have increased clarity around definitions and criteria for code level selection based on good patient care.

Implementing CPT Evaluation and Management Revisions
Video presentations with step-by step guidance to help the health care community hit the ground running with the new E/M office visit documentation and coding guidelines.

CPT Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99XXX) Code and Guideline Changes
A detailed description of the revisions to the E/M office visit documentation and coding guidelines.

CPT E/M Office Revisions Level of Medical Decision Making (MDM)
A reference source illustrating medical decision-making revisions to the E/M office visit documentation and coding guidelines.

RUC Recommendations for E/M Office Visits
All RUC minutes, recommendations, voting and data related to the consideration of the E/M Office Visits (99202-99215)

The AMA continues on every front to reduce administrative burdens in health care. Through our research, collaborations, advocacy and leadership, the AMA is working to make the patient‐physician relationship more valued than paperwork, preventive care the focus of the future, technology an asset and not a burden, and physician burnout a thing of the past.

Media Contact:

Robert J. Mills

ph: (312) 464-5970

[email protected]

About the American Medical Association

The American Medical Association is the physicians’ powerful ally in patient care. As the only medical association that convenes 190+ state and specialty medical societies and other critical stakeholders, the AMA represents physicians with a unified voice to all key players in health care.  The AMA leverages its strength by removing the obstacles that interfere with patient care, leading the charge to prevent chronic disease and confront public health crises and, driving the future of medicine to tackle the biggest challenges in health care.

Featured Stories