# New E/M Guidelines for 2021



## momo2 (Feb 26, 2020)

Hello,

After reading the article in the Healthcare Business Monthly, I have a question about using the "time" ranges listed.  Since providers typically see patient's every 15 minutes, it would appear that they would only be able to ever bill  a 99212 - 10-19 minutes for established patient?


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## AmandaBriggs (Feb 26, 2020)

From what I understand of the new E/M guidelines for 2021, providers will be able to choose between using time, which will be calculated differently and will include all of the time spent on the patient's care by the provider and not just the face-to-face time, or the provider may also choose their level of service based on MDM.  The AMA has a great overview of these upcoming changes.  Here is the link:
https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf


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## csperoni (Feb 27, 2020)

Exactly - just like now you can code based on history, exam & MDM or time (if >50% counseling/coordination of care), starting 2021, you code either:
1) Based on MDM
2) Time - with the changes that counseling does NOT need to be > 50% and not only face-to-face time. It includes reviewing records, charting, ordering meds, etc on the same day as the encounter. 
And Amanda, that is a great link, thanks!!

I will note I have yet to hear the official rules about how the time must be documented.  For example, can the physician just state "spent a total of 35 minutes on all care for this patient this date", or does it need to specify "10 minutes reviewing PETCT report, 20 minutes on encounter, 5 minutes charting."  Since the intention of this change is to reduce administrative burden on the physicians, I am hoping it will be very straightforward.  
I also wonder regarding prolonged services.  Historically, we would sometimes bill prolonged services.  Some carriers for prolonged services required the note not to just specify the amount of time, but the actual time - i.e. 2:03p-3:16p.  That was so cumbersome for us that we stopped billing prolonged altogether.


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## Cynthia Hughes (Apr 15, 2020)

csperoni said:


> Exactly - just like now you can code based on history, exam & MDM or time (if >50% counseling/coordination of care), starting 2021, you code either:
> 1) Based on MDM
> 2) Time - with the changes that counseling does NOT need to be > 50% and not only face-to-face time. It includes reviewing records, charting, ordering meds, etc on the same day as the encounter.
> And Amanda, that is a great link, thanks!!
> ...


The intent of the 2021 changes is to reduce documentation burden so that only the total amount of time needs to be documented. However, payers may choose to require more documentation. The rules for the Medicare Physician Fee Schedule in 2021 may provide additional information. Cindy


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