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2021 E/M Coding Update

Nov 29, 2019 6:27 pm

As a rheumatologist, I pride myself on being an advocate for my patients, but I'm not always an advocate for my profession or myself. I’ve often struggled with the question “should rheumatologists be involved in policy?” Should we be political? After spending time with the CSRO (Coalition for State Rheumatology Organizations) I argue that we need to be our own advocates and we cannot afford to wait. Luckily, we have some help in this department. 

I had the pleasure of attending the CSRO legislative update while at #ACR19 and wanted to shed some light on one hot topic, the E/M coding from CMS and the 2021 update.
Beginning in 2021, CMS will implement payment, coding, and additional documentation changes for E/M office/outpatient visits, specifically: 
- There will no longer be a 99201 code, effectively making only 4 EM codes for new patients. The known EM code levels 1-5 will remain for established patients. 
- For all new or established visits, we will still have the choice to document using the current framework, MDM (medical decision making) or time. 
- You will only need to perform a history and exam as deemed “medically appropriate” and are not required for code level determination. 
- In addition: there will be add-on CPT code (99xxx) to describe extended office visits with patients as well as a Medicare-specific add on codes detailing complexity associated with EM visits.
Of note, the details of these additional codes have yet to be fully fleshed out. Effectively, we need to push for clarity on this coding!
Ultimately, this will lead to an aggregate of +15% for all care in rheumatology based on EM coding. While the details are still fuzzy, this is an important change for rheumatologists. The CSRO envisions total transparency to best understand how we can use these future codes to care for our patients, so please tune in to and for further information and get involved!  


Rachel Tate, DO is in clinical practice at Arthritis and Rheumatology Associates of Palm Beach. Her areas of interest include patient advocacy, musculoskeletal ultrasound, pregnancy in connective tissue disease, and spondyloarthropathies.

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