Neurology & Pain Management Coding Alert

Question: An established patient reports to the provider for an office evaluation and management (E/M) service. The provider performs a problem focused history and examination. The encounter also featured straightforward medical decision making (MDM), and is extremely short: 8 minutes. How should I report this encounter?

Illinois Subscriber

Answer: It depends on the date of service (DOS) for the E/M encounter. The rules changed as of January 1, and you could code this a couple of different ways. The correct choice will hinge on the DOS.

In 2020: If the encounter has a 2020 DOS, report 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. …) for the encounter.

In 2021: If the encounter has a 2021 DOS, report 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter. …) for the encounter.

Explanation: Since 99201 is a valid code until Dec. 31, 2020, you should report it for this encounter if it occurred in that time frame. The visit fits the description for a 99201 claim perfectly.

In 2021, 99201 will not exist — so debating whether to report it is futile. The visit does, however, satisfy the straightforward MDM requirement for the 2021 version of 99202, which features an updated descriptor.