2021 Evaluation and Management Coding Updates

As you may be aware, the American Medical Association released new evaluation and management (E/M) coding guidelines for 2021, with revised code descriptors for certain office and outpatient E/M codes using medical decision making (MDM) or time to dictate code selection.

Harvard Pilgrim would like to clarify that if you are selecting an E/M service in 2021 and time is the basis for code selection, the total time must be documented in the member’s medical record. Documentation must reflect the physician’s time spent having direct patient contact, including face-to-face time and additional non face-to-face time (excluding telephone encounters), which could include:

  • Preparing to see the patient
  • Obtaining and/or reviewing the patient’s history
  • Performing examination and/or evaluation
  • Counseling and educating the patient/family/caregiver
  • Ordering tests, procedures, or medications
  • Referring to and communicating with other health care professionals (if not already separately reported)
  • Documenting clinical information in the patient’s health record
  • Independently interpreting results (if not already separately reported)
  • Care coordination (if not already separately reported)

Please note that services rendered by another provider or support staff will not be considered for reimbursement when time is the basis for code selection. For more information, please refer to Harvard Pilgrim’s updated commercial Evaluation and Management Payment Policy.

Editor’s Note: This article and the Evaluation and Management Payment Policy were updated on April 9, 2021 to remove a requirement to document start and end time of the visit.


Publication Information

Helen Connaughton,
Director, Network Operations

Annmarie Dadoly,
Editor

Joseph O’Riordan,
Writer

Kristin Edmonston,
Production Coordinator