Backup: 2021 Office-Based E/M Changes

The largest overhaul to the office-based evaluation and management (E/M) services since 1997 will take place on January 1, 2021. Representatives from Current Procedural Terminology (CPT®) and the RUC (resource-based relative value scale update committee) got together representing primary care specialty societies (like the AAP) to determine the best approach for overhauling the office-based E/M services. As a reminder, this change will only impact CPT® codes 99201-99215!

For information on the March 9, 2021 CPT Technical Correction/Errata see the New 2021 Office-Based E/M Updates from CPT Errata

Guiding Principles for the 2021 Updates

1. Decrease documentation burden and note bloat
2. Make code level selection more intuitive
3. To decrease the need for audits, through the addition and expansion of key definitions
4. Retain current code distribution

Code level should be based on physician work in managing the patient’s problem(s) with focus on decision making, not simply on volume of tests/treatments

Key Elements to the Overhaul

• Eliminating history and physical exam as elements for code selection
• Allowing physicians to choose whether their documentation is based on MDM or total time
• Changing MDM criteria to move away from simply adding up tasks to instead focus on tasks that affect the management of a patient’s condition

High Level Summary of Changes

1. Deleted 99201 (lowest code selection for a new patient is 99202)
2. MDM or Time to select code
3. Revised MDM 
4. Revised Time 
5. New prolonged services code 
6. Re-valuation of the E/M service codes
7. FAQs: 2021 Office-Based E/M Changes

Additional Resources

• AAP Pedialink Module
• AAP Coding Publications:
  • AAP Pediatric Coding Newsletter (Subscription)
    Monthly articles dedicated to the 2021 office-based E/M changes
  • Pediatric Office-Based Evaluation and Management Coding:2021 Revisions
  • Pediatric Evaluation and Management: Coding Quick Reference Card 2021
    This coding card features 2021 E/M changes for quick review of office-based E/M services to ensure you are coding correctly based on documentation.
  • Coding for Pediatrics 2021
    This comprehensive manual is your guide to pediatric coding. A new chapter is dedicated to the 2021 E/M changes, plus many other chapters to assist with your other pediatric coding such as preventive medicine.
• AAP News: Coding Corner
• AMA CPT Code and Guideline Change
• Coding at the AAP Home