Wiki Question: 2021 Updated E/M Guidelines for Office Visits

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jenmendoza

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I apologize in advance if this question has already been answered. But I am a bit confused, based on the 2021 guidelines the CPT codes and usage for the office visit still contains the corresponding time/duration the provider can spend with the patient. So... do we use the CPT codes based on the time alone still? I was under the impression that we will code it based on the scoring and complexity of the visit regardless of the amount of time spent with the patient.

Any corrections or answers are highly appreciated!
 
Pre 2021, outpatient E/M could be coded on either history/exam/MDM OR face to face time if > 50% of time was counseling/coordination of care.
Starting 2021, outpatient E/M can be coded on either MDM only OR total provider time the date of encounter.
Neither the elements nor time take precendence. You may use whichever is more beneficial.
Please note that time for 2021 outpatient is TOTAL provider time the date of encounter (can include time spent reviewing records, writing Rx, charting, etc.; exclude time spent performing additional procedures separately billed for like EKG, ultrasound, biopsy, suture) and no longer needs to be >50% counseling/coordination of care.

In my experience, an efficient clinician with competent staff can complete the required MDM in less time than the time guidelines at least 95% of the time. There are certain specialties, or certain time consuming patients where billing on time might be more beneficial.
 
csperoni said:
Pre 2021, outpatient E/M could be coded on either history/exam/MDM OR face to face time if > 50% of time was counseling/coordination of care.
Starting 2021, outpatient E/M can be coded on either MDM only OR total provider time the date of encounter.
Neither the elements nor time take precendence. You may use whichever is more beneficial.
Please note that time for 2021 outpatient is TOTAL provider time the date of encounter (can include time spent reviewing records, writing Rx, charting, etc.; exclude time spent performing additional procedures separately billed for like EKG, ultrasound, biopsy, suture) and no longer needs to be >50% counseling/coordination of care.

In my experience, an efficient clinician with competent staff can complete the required MDM in less time than the time guidelines at least 95% of the time. There are certain specialties, or certain time consuming patients where billing on time might be more beneficial.
Click to expand...
Thank you so much for this, this is very helpful! ^o^
I have always been confused because I thought we code office visits based on complexity alone and not by the duration of time the provider spent with the patient.
Do you think it would be beneficial if the provider would include the amount of time spent with the patient in their chart notes? Just so denied claims for wrong codes can be avoided. ; v ; )
 
Hi there, because you can now base office codes on MDM or time, it could be a good habit for practitioners to include the information, but it should be a group decision.

Because you can count time for certain activities that take place before or after the face-to-face encounter on the date of the encounter, capturing the appropriate time is trickier than under the counseling/coordination of care guidelines. However, in some instances it may allow them to code at a higher level than MDM and time-based coding is the only way to report the prolonged service code.

After discussing the pros and cons with them they may decide that the effort of keeping track of the time isn't worth it and they'll stick with MDM. :ROFLMAO:
 
jkyles@decisionhealth.com said:
Hi there, because you can now base office codes on MDM or time, it could be a good habit for practitioners to include the information, but it should be a group decision.

Because you can count time for certain activities that take place before or after the face-to-face encounter on the date of the encounter, capturing the appropriate time is trickier than under the counseling/coordination of care guidelines. However, in some instances it may allow them to code at a higher level than MDM and time-based coding is the only way to report the prolonged service code.

After discussing the pros and cons with them they may decide that the effort of keeping track of the time isn't worth it and they'll stick with MDM. :ROFLMAO:
Click to expand...
Hello! I definitely agree on this... it is rather difficult for me to push the charge out if they don't specify the reason for their intended office visit code.
Thank you so much for this! ^o^
 
jkyles@decisionhealth.com said:
Hi there, because you can now base office codes on MDM or time, it could be a good habit for practitioners to include the information, but it should be a group decision.

Because you can count time for certain activities that take place before or after the face-to-face encounter on the date of the encounter, capturing the appropriate time is trickier than under the counseling/coordination of care guidelines. However, in some instances it may allow them to code at a higher level than MDM and time-based coding is the only way to report the prolonged service code.

After discussing the pros and cons with them they may decide that the effort of keeping track of the time isn't worth it and they'll stick with MDM. :ROFLMAO:
Click to expand...
Fully agree with this for 99% of providers/practices. There are certain physicians or specialties (palliative care comes to mind) where each patient can be rather time consuming, and those types of physicians/practices may benefit from time documentation.
In my experience, an efficient clinician with appropriately trained staff can reach the MDM in less time than the range almost every time. I only ask my clinicians to document time for the unusual time consuming patient who decided to bring 4 family members to the visit, and there are 5 sets of repeating questions.
 
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