2021 CPT Code Set Simplifies E/M Coding, Adds COVID-19 Tests

The American Medical Association (AMA) implemented major changes to the 2021 Current Procedural Terminology (CPT) code set in an effort to simplify coding and documentation of office visits and other outpatient evaluation and management (E/M) services.

The code set released earlier today modified E/M office visit codes 99201 through 99215 to eliminate history and physical exam as elements for code selection and enable physicians to select the code levels based on medical decision-making or total time.

The E/M office visit modifications also include more details added to the CPT code descriptors and guidelines to promote greater payer consistency.

The AMA described the changes to the CPT codes as the “first major overhaul in more than 25 years to the codes and guidelines for office and other outpatient evaluation and management (E/M) services.”

CMS is also looking to adopt the revised codes as part of its Medicare Physician Fee Schedule in 2021.

“To get the full benefit of the burden relief from the E/M office visit changes, health care organizations need to understand and be ready to use the revised CPT codes and guidelines by Jan. 1, 2021,” AMA President Susan R. Bailey, MD, said in the announcement. “The AMA is helping physicians and health care organizations prepare now for the transition and offers authoritative resources to anticipate the operational, infrastructural and administrative workflow adjustments that will result from the pending transition.”

The changes to the CPT codes used for outpatient E/M services are meant to streamline coding and documentation for providers and grant them more flexibility to focus on patient care rather than “clinically irrelevant administrative burdens that led to time-wasting note bloat and box checking,” AMA said.

E/M coding requirements have contributed to clinician burnout for decades, according to CMS.

The federal agency finalized future changes to E/M coding and documentation in the Medicare Physician Fee Schedule in 2019. More recently, the proposed rule for the 2021 Medicare Physician Fee Schedule included updated reimbursement rate increases for most of the revised codes.

Clinicians have been supportive of changes to E/M coding and documentation of the services from CMS, which are in line with the AMA’s modification of its CPT code set. Industry groups have said the new codes and guidelines will “streamline documentation requirements” and “contribute to a better environment for healthcare professionals and their Medicare requirements.

Also among this year’s important changes to the CPT code set are new medical testing services developed during the COVID-19 pandemic, including diagnostic and antibody tests for the novel coronavirus.

Since the start of the pandemic earlier this year, the AMA has approved and immediately implemented a dozen new CPT codes to allow for the documentation of COVID-19 testing, including five Proprietary Laboratory Analyses (PLA) codes.

Per the standard early release delivery process for CPT codes, providers had to manually upload the code descriptors of the COVID-19 test codes into their EHR systems.

The new codes are now part of the complete CPT set in the data file for 2021.

The data file will also include new CPT codes for other recent digital medicine innovations, including retinal imaging (92229) and external extended electrocardiogram monitoring (93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248), AMA highlighted.

The industry group also revised retinal imaging codes 92227 and 92228 to better support diabetic retinopathy screenings.

Overall, the 2021 CPT code set contained 328 editorial changes, including 206 new codes, 54 deletions, and 69 revisions. The majority of new codes in 2021 (63 percent) involve new technology services described in Category III CPT codes and the continued expansion of the PLA section of the CPT code set, AMA reported.