CPT 2021 Changes Frequently Asked Questions

CMS, together with the American Medical Association (AMA), have revised the Evaluation and Management (E/M) office visit CPT codes.

The update to the documentation standards aims to reduce administrative burden on physicians. Documentation for E/M office visits moves away from mandatory standards focused on checking boxes and instead centers on how physicians think and care for patients.

The changes coming include E/M guideline additions, revisions, restructuring, deletion of code 99201, and revision of codes 99202–99215.

Starting Jan. 1, 2021, New Patient and Established Patient visit codes can be based on:

• Medical decision-making (MDM), including a new complexity code for highly complex visits.

  OR

• Total time spent on the patient on the date of the encounter (includes non face-to-face time), including a new 15-minute add-on.

On Jan. 1, 2021, when coding a patient visit in iKnowMed Generation 2, the billing codes you can select will change based on the year of the visit date.

If you saw the patient on or before Dec. 31, 2020, the billing code screen will remain the same.

Two visual improvements to the billing code screen will be visible after the Dec. 12 release of version 3.0.19:

• A blue band to break up the code list from the section label

• Blue ovals around selected codes at the top of the screen to make it easier to distinguish each code when more than one code is selected.

If you saw the patient on or after Jan. 1, 2021, the updated code sets will be available in new and established patient type visits.

On Jan. 1, 2021, updated code sets will be available in new and established visit types.

Code descriptions will summarize the MDM level and the minutes associated with the code. A new drop down menu will be available to select the total minutes spent on the date of the encounter. iKnowMed Generation 2 will calculate and select codes for you for these visit types.

On Sunday, Dec. 27, 2020, the Consolidated Appropriations Act, 2021, was signed into law. It includes an unanticipated three-year delay in implementing the new CMS visit complexity code G2211.

As a result of the late-breaking change, G2211 will still be visible on the billing code screen starting Jan. 1, 2021, but should not be used. Since Medicare expected high utilization of this code, we placed it as a sub-menu item under each new and established patient code.

G2211 will be removed from the billing code screen in early January 2021 to reflect the changes outlined in the law.

On Jan. 1, 2021, a drop down will be available to select the number of minutes spent on the date of the encounter and iKnowMed Generation 2 will calculate and select new and established patient codes based on CMS Final Rule time definitions and prolonged visits definitions related to G2212.

If you prefer to select a code based on MDM or do not want to enter minutes, then you can select a code on the screen in the same way it is done iniKnowMed Generation 2 today.

Currently, guidelines from both the AMA and CMS are final. Below we’ve compiled a summary of what CMS accepted/rejected from the AMA’s guidelines and how it will be incorporated into iKnowMed Generation 2:

• CMS agreed to adopt all CPT 2021 new and established patient office codes 99202-99215 with their descriptions, MDM level, and time components. You will see these mutually agreed upon terms and time descriptions on the billing screen in iKnowMed Generation 2.

• CMS agreed to stop using 99201 and 99221 no longer includes a time component.

• CMS agreed 99354 and 99355 should no longer be used to report prolonged time with new and established patient codes 99202-99215. You will no longer see these codes available in iKnowMed Generation 2 starting in 2021 for new and established patient E/M visits.

• CMS agreed with the AMA's usage of the new 15-minute prolonged visit code 99417. As a result, the RVU for 99417 in the 2021 Fee Schedule is 0 and the code will not be paid.

• CMS created a 15-minute prolonged visit code to replace 99417. This code is G2212 and will be available instead of 99417 on the iKnowMed Generation 2 billing screen. CMS finalized times for prolonged visits, requiring more time spent with patients than the AMA. A prolonged visit can't be reported based on the CMS Final Rule until the maximum time for a level 5 visit is exceeded by at least 15 minutes. This equates to 89 minutes for new patients and 69 minutes for outpatient visits. iKnowMed Generation 2 will adhere to the CMS Final Rule when calculating prolonged visits.

Our teams have carefully monitored the CMS Final Rule and have updated iKnowMed Generation 2 so the codes users need are available.

We will be making further updates to accommodate the delay in implementing G2212, the newly created CMS add-on complexity code in early January 2021.

We remain committed to making this transition as smooth as possible for our users.