Question 2021 E/M Clarifications to MDM

TAOSA

Guest
Messages
39
Location
Capital City Coders
Best answers
0
Hello all!

These new guidelines only apply to office visit codes (99202-99205, 99211-99215). However, my question is about all the other E/M codes. Those codes still require the Hx and PE elements to be met. Does anyone know if the new clarifications on MDM would transfer to codes following 1997/1995 guidelines or if the MDM table we have always used is still the norm?

Thanks!
Tiffany Huffman
 

lcolborn

Networker
Messages
85
Best answers
0
From what I have heard from the multiple webcast and webinars that I have attended, the new 2021 E/m Guidelines are either based on time or MDM. However, they have their own definitions and that elements are to be met in selecting the Cpt code by the providers. If in 1995 and 1997, we check the bullets, not this time..., it's elements. And no on the new rules for 1995/1997. Their rules stays the same .
Check the MDM grid from AMA as well as the Time based reporting information. Note that time thresholds went up per code and they constitute face to face and non face to face with the patient, and all the activities with the total time documented on the date of service ( no after or before date) . Medical staff time is not counted, only the provider's.
 

anne32

Networker
Messages
98
Best answers
0
Can you explain G2211 and when it would be used? Are we able to attach it to all office visits 99202-99205, 99212-99215?
 

csperoni

True Blue
Messages
911
Location
Selden
Best answers
3
Does anyone have information on what a coder should do if both time and MDM are documented? Which is to be used for coding?
The 2021 guidelines are time or MDM. You may use whichever you wish. Just like now it is 1995 or 1997 guidelines, or time (if > 50% in counseling/coordination of care).
 

smihm

Contributor
Messages
20
Location
ft myers
Best answers
0
Can you explain G2211 and when it would be used? Are we able to attach it to all office visits 99202-99205, 99212-99215?
G2211 is an add on code for visit complexity -the way it is defined appears to be for pts with long term chronic conditions - not an acute problem
here is a link to a good explanation of the code www.codingintel - go to E&M Changes 2021-Physician Final Fee Schedule Final rule changes on the far right- this is great for Family Practice and Internal Medicine as well as some Specialties but for others like Pediatrics I'm struggling to see where this would apply as most Pediatric visits are acute problems in nature .... anyone else have an opinion on this would love to hear
Can you explain G2211 and when it would be used? Are we able to attach it to all office visits 99202-99205, 99212-99215?
 
Messages
3
Location
Calabash, NC
Best answers
0
I believe G2211 and G2212 are add on codes for Medicare only, if I am correct. G2211 has to do with added complexity, G2212 has to do with prolonged time. I'm trying to sort through this as well and appreciate any input.
 
Messages
3
Location
Calabash, NC
Best answers
0
Also, I think 99417 is the add on code for prolonged services with regular visits but can only be used with codes 99205 or 99215 (non-medicare) because those are time based visits. I believe the G2211 code can only be used with the MDM codes, if I am not mistaken.
 

cgaston

Expert
Messages
494
Location
Clarence, NY
Best answers
0
The whole point of these changes is that you can use either the MDM or the time when selecting your code level. As long as the documentation supports the code I would use whichever one gives me a higher level.

So your document supports a 99213 using MDM and a 99214 using time, why wouldn't you choose the 99214 when the documentation supports it?
 

kbrandt101

Contributor
Messages
15
Location
Citrus Heights, CA
Best answers
0
G2211 is an add on code for visit complexity -the way it is defined appears to be for pts with long term chronic conditions - not an acute problem
here is a link to a good explanation of the code www.codingintel - go to E&M Changes 2021-Physician Final Fee Schedule Final rule changes on the far right- this is great for Family Practice and Internal Medicine as well as some Specialties but for others like Pediatrics I'm struggling to see where this would apply as most Pediatric visits are acute problems in nature .... anyone else have an opinion on this would love to hear
Hi. Your link could be great but it's also a pay for site. Would you be able to add a little summary of what you were able to confirm from the article? Would be greatly appreciated as I'm trying to define for my providers what would qualify as visit complexity for reporting.
 

smihm

Contributor
Messages
20
Location
ft myers
Best answers
0
Hi. Your link could be great but it's also a pay for site. Would you be able to add a little summary of what you were able to confirm from the article? Would be greatly appreciated as I'm trying to define for my providers what would qualify as visit complexity for reporting.
No problem- this information is under the free content - Sorry its a little long

1607964110336.png
 
Top