Author: Lori Carlin, CPC, COC, CPCO, CCS
Director, Professional Coding Services

 

Author: Autumn Hull, CPMA, CPC, CEMC, CCA, CPAR
Supervisor, Professional Audit Services


(303) 801-0111


Beginning January 1, 2021, the new Centers for Medicare and Medicaid Services (“CMS”) Evaluation and Management (“E/M”) guidelines will take effect for Office and Other Outpatient codes *99202-99205 and 99212-99215.  Assignment of these codes will now be determined based on medical decision making (“MDM”) or time.  The need for an extended history and / or exam to support code assignment is eliminated.  The documentation of an appropriate history and examination is left to the performing provider’s judgement.  In this article, a comparison of the old vs. new guidelines for establishing medical decision making will be discussed, compared, and contrasted.  Below is the American Medical Association’s table for reference.

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