Pulmonology Coding Alert

Question: We are finally getting around to training our staff on how the outpatient E/M codes will change in 2021 and we have received a few questions from our staff members. One of them is about the deletion of code 99201. If it’s going away, how will we report level 1 new patient E/M visits in January?

Alabama Subscriber

Answer: Although it may seem jarring to see the deletion of 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 …), the change will arrive hand in hand with another major adjustment, which will allow you to report 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components…) in its place.

Here’s why: Effective January 1, 2021, code 99201 will be eliminated, allowing you to select from 99202-99215 for outpatient visits. However, since you’ll be able to select the appropriate code based on medical decision making (MDM) next year — and the MDM level for both 99201 and 99202 is “straightforward” — so you aren’t likely to miss 99201 at all.

Example: You see a new patient who presents with controlled COPD and you document a visit with straightforward MDM. If you’re basing the visit solely on MDM, you’ll report 99202 in this situation.