Chiropractic E/M Services - Revised Coding Guidelines for 2021

Updated: Dec 30, 2020

Changes are coming for Evaluation & Management codes beginning January 1, 2021. These changes will specifically affect coding for office and outpatient visits (99201-99215), making them extremely important for Chiropractic offices to review.

The revised coding guidelines for outpatient E/M services represent the first major overhaul of E/M reporting in more than 25 years. The coding guidelines are simpler and more flexible and were developed by the AMA and the Centers for Medicare and Medicaid services in a combined effort to “decrease the administrative burden of documentation and coding“, thus relieving doctors of some clinically irrelevant, time-wasting administrative burdens.

Here is an outline and a summary of the upcoming E/M Coding and Documentation changes. Stay tuned over the coming weeks for detailed posts offering more specific guidance on how to optimize the use of your DocPlus system in accordance with the new guidelines.

New E&M Coding Rules for 2021

  • New Patient, Level 1 code (99201) will be eliminated completely, reducing the number of levels for new patient E&M services to four.

  • For established patients, the standard five coding levels will remain.

  • History and physical examination will no longer be determining factors for selecting the appropriate level of care. (This does NOT mean you are no longer required to document these components. Clinically relevant history and exams must still be documented.)

  • Medical Decision Making (MDM) or Time will be used to determine the appropriate level of E&M.

AMA’s 2021 Guidelines for Office/Outpatient E/M Codes: New Patient

Let us take a closer look at the coming changes, starting with the new patient codes and descriptors.

99201: This code has been eliminated from the 2021 CPT code set.

99202-99205: In 2021, new patient codes 99202-99205 will no longer require the 3 key components or reference typical face-to-face time. Instead, each of the services includes a “medically appropriate history and examination,” and code selection will be based on the level of MDM or total time spent on the date of the encounter.

Below, you can see the differences between the old code descriptor and the new code descriptor for 99203.

OLD 99203 - Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.

NEW 99203 - Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter.

The descriptors for 2021 codes 99202-99205 follow the same structure as the 99203 example above.

The following table shows the requirements for the NEW PATIENT E/M codes in 2021.**