CPT MANUAL PROFESSIONAL EDITION PDF CODE
Code 99417 is to be used for “prolonged office or other outpatient E/M services beyond the minimum time of the primary procedure.” Parenthetical guidance for 99417 states to use the add-on code in conjunction with 99205 (75 minutes) and 99215 (55 minutes) and cannot be used for any time unit less than 15 minutes.Ĭoders who are responsible for assigning codes 99201-99215 should be sure to review all CPT guideline updates, new parenthetical notes, and updated code descriptions and make sure all coders, physicians, and applicable staff are ready for these key code changes and documentation requirements. The E/M services section also includes a new add-on code for prolonged services. The time must be clearly documented in the medical record for the coder to be able to use time alone to calculate the levels. The guidelines now state time of encounter as the total time of the encounter, not 51 percent or more of the encounter.Risk of complications or morbidity of patient management.The complexity and amount of data to be reviewed.The complexity and number of problems addressed in the visit.Key differences for office and outpatient visits include: The elements that outline each of the four MDM levels are different. There is a new MDM table to calculate the MDM level of service.For office visits, the E/M guidelines state coders may select the appropriate level of E/M service by using either the medical decision-making (MDM) table or total time on the date of the encounter.For office visits, the history and examination terminology has been removed from the code description and replaced with the terms “medically appropriate history and/or exam.” There also are new time thresholds assigned to each CPT code description.Code descriptions were changed for office or outpatient service E/M codes 99202-99215.Code 99201 has been deleted and parenthetical notes state to use code 99202 instead.Key changes to note for the office and other E/M services codes (99202-99215) and guidelines include: According to the AMA press release regarding the 2021 CPT code updates, the office and other E/M services codes and guidelines received its “first major overhaul in more than 25 years.”Į/M codes for provider offices and other outpatient services are still divided into new patient services (99202-99205) and established patient services (99211-99215). This article reviews the key changes for 2021 by CPT code section.įor years there’s been a lot of discussion among the AMA, coding professionals, and other industry leaders about the need to make changes to the Evaluation and Management (E/M) guidelines and codes.
The graph below shows a summary of the changes for each CPT code section. There are a total of 329 CPT code changes for 2021, including 206 code additions, 54 code deletions, and 69 code revisions. This year, the AMA did not disappoint with the number of changes or the significance of these changes. On September 1, 2020, the American Medical Association (AMA) released the 2021 Current Procedural Terminology (CPT) code set, which became effective January 1.