The AMA conducted a peer-reviewed study to determine the amount of time that could be saved after CMS’ changes for E/M encounters are fully implemented.
They found that the changes would bring a conservative reduction of 2.11 minutes per visit. Assuming a physician sees 20 patients per day, physicians would gain about 42 minutes a day to focus on patient care.
- Reduce administrative burden on documentation and coding
- Reduce the need for audits by adding and expanding key definitions and guidelines
- Reduce documentation in the medical record that is not needed for patient care
- Keep payment for E/M resource-based and eliminate the need to redistribute payments between specialties
- Deletion of level outpatient visit CPT code 99201
Summary of Revision E&M 2021
Eliminate documentation of the history and physical exam as components for E/M code selection, however, AMA asked the providers should continue the documentation part of the history and physical exam in order to evaluate the patient's care and conditions.
Office and other outpatient services include a medically appropriate history and/or physical examination when performed. The provider determines the nature and extent of the history and/or exam required. The extent of history and exam do not affect code selection for E/M codes 99202–99215. However, all services performed should be documented appropriately in the medical record.
The physicians can select the E/M level based on the MDM or on total time.
MEDICAL DECISION MAKING
The three elements of MDM is important to select the level
- The complexity of the patient’s presenting problem,
- Data to be reviewed,
- Risk is not materially changed, but the work-group did extensively edit and clarify definitions in the E/M guidelines
Time
Time is defined as MINIMUM TIME, not typical time, and is measured as the total time the physician or other qualified healthcare professional spends on the date of service.
- Face-to-face and
- Non-face-to-face time
This includes time in activities that require the physician or QHP and does not include time in activities normally performed by clinical staff.
The time calculation would be considered as physician/other qualified health care professional spends time on the day of the encounter includes the following activities when performed,
- Preparing to see the patient (e.g., review of tests)
- Obtaining and/or reviewing the separately obtained history
- Performing a medically appropriate examination and/or evaluation
- Counseling and educating the patient/family/caregiver
- Ordering medications, tests, or procedures
- Referring and communicating with other health care professionals (when not separately reported)
- Documenting clinical information in the electronic or other health records
- Independently interpreting results (not separately reported) and communicating results to the patient/family/caregiver
- Care coordination (not separately reported)
Prolonged Service
Use 99417 & G2212 in conjunction with 99205, 99215 and do not report 99417 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416
Do not report 99417 for any time unit less than 15 minutes.
The payers will not reimburse you unless you report it with an appropriate primary code because this code is an add–on code,
Confirm payer coverage and requirements for this code.
- Medicare requires this code G2212 in place of +99417.
- Private payers require this code 99417 in place of G2212
As an example of proper use, when coding based on time, you report 99205 for a new patient visit lasting 60 to 74 minutes. Once the time reaches 89 minutes, you also may report +G2212 because 89 minutes is 15 minutes beyond the maximum required time of 74 minutes.
When coding based on time, you report 99205 for a new patient visit lasting 60 to 74 minutes. Once the time reaches 75 minutes, you also may report +99417 because 75 minutes is 15 minutes beyond the minimum required time of 60 minutes.
When coding based on time, you report 99215 for an established patient visit lasting 40 to 54 minutes. Once the time reaches 55 minutes, you also may report +99417 because 75 minutes is 15 minutes beyond the minimum required time of 60 minutes.
| Total Duration of New Patient Office or Other Outpatient Services (use with 99205) | Code(s) |
| less than 75 minutes | Not reported separately |
| 75-89 minutes | 99205 X 1 and 99417 X 1 |
| 90-104 minutes | 99205 X 1 and 99417 X 2 |
| 105 minutes or more | 99205 X 1 and 99417 X 3 or more for each additional 15 minutes |
| Total Duration of Established Patient Office or Other Outpatient Services (use with 99215) | Code(s) |
| less than 55 minutes | Not reported separately |
| 55-69 minutes | 99215 X 1 and 99417 X 1 |
| 70-84 minutes | 99215 X 1 and 99417 X 2 |
| 85 minutes or more | 99215 X 1 and 99417 X 3 or more for each additional 15 minutes |
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