Happy New Year! To help you celebrate 2021, the ever-confusing E/M codes have been changed! These changes will affect chiropractors a little, but they’re a BIG DEAL to medical doctors.
Basically, we’re still required to perform an appropriate history and exam. Nothing new there. Instead of worrying about what kind of history, what kind of exam and what kind of medical decision making, we’re now to select the appropriate E/M code based on either…
TIME or MEDICAL DECISION MAKING
2021 Requirements for E/M Codes 99202-99205 | |||
Code History/Exam MDM Total Minutes | |||
99202 | Medically appropriate history and/or exam | Straightforward | 15-29 |
99203 | Medically appropriate history and/or exam | Low | 30-44 |
99204 | Medically appropriate history and/or exam | Moderate | 45-59 |
99205 | Medically appropriate history and/or exam | High | 60-74 |
In addition, they’ve eliminated CPT code 99201. Here are the basics:
2021 Requirements for E/M Codes 99211-99215 | |||
Code | History/Exam | MDM | Total Minutes |
99211 A problem that may not require the presence of the physician or other qualified health care professional, but the service is provided under the physician’s or other qualified health care professional’s supervision. | |||
99212 | Medically appropriate history and/or exam | Straightforward | 10-19 |
99213 | Medically appropriate history and/or exam | Low | 20-29 |
99214 | Medically appropriate history and/or exam | Moderate | 30-39 |
99215 | Medically appropriate history and/or exam | High | 40-54 |
Code Based on Time (documenting time in and time out and total time is the best and safest
way to do this).
9920X/9921X – a total of x minutes spent:
Preparing to see the patient (e.g. review of tests)
Obtaining and/or reviewing separately obtained history
Performing a medically appropriate history and/or examination
Counseling and educating the patient/family/caregiver
Ordering tests or procedures
Referring and communicating with other health care professionals (when not separately reported)
Documenting clinical information in electronic health/medical record
Independently interpreting results (not separately reported) and communicating results to the patient/family/caregiver
Care coordination (not separately reported)
Before you see the Medical Decision Making information, I’ll cut to the chase: the vast majority of chiropractors should/will use TIME as the E/M deciding factor, NOT medical decision making. So, don’t panic.
To see the rules regarding Medical Decision Making, you can get that here: https://www.ama-assn.org/system/files/2019-06/cpt-revised-mdm-grid.pdf
Remember what I said, though. Don’t. Panic.
In my EMR, we programmed it so we just need to click on the time and if it’s a new or established patient, and the software does the rest. It selects the appropriate code for me. If I were to use medical decision making, I’d have to refer to the grid link I wrote above.
To see how I document this, you can email me at drgregg@TheBulletProofChiro.com and I’ll send you a brief video.
Be BulletProof.