E&M Changes: Are You Ready

CMS has made it clear that they are committed to their Patients Over Paperwork initiative. They are currently seeking additional feedback and input regarding elimination of specific Medicare regulations that require more stringent supervision than the existing state scope of practice laws or that limit health professionals from practicing at the top of their license. This is specific to the supervision restrictions that were alleviated in the OPPS Final Rule 1717-FC.

Per CMS:

If you submitted comments on these topics to our 2019 Request for Information on Reducing Administrative Burden to Put Patients over Paperwork, thank you! We are reviewing those submissions. We welcome any additional recommendations. Please send your recommendations to PatientsOverPaperwork@cms.hhs.gov with the phrase “Scope of Practice” in the subject line by January 17, 2020.

Part of the Patients Over Paperwork initiative is reduce the burden of redundant work through coding and documentation reform. This is the intent of the E&M reform, which currently uses methods and approaches that are 25 years old. This will go into effect January 1, 2021. The selection of the patient visit, 99202-99215 will be based on time or medical decision making.

*Note the 99201 will be deleted


  • Total time on the date of the encounter
  • Face to face and non-face to face. This excludes activities performed by clinical staff

Medical Decision Making

  • establishing diagnoses
  • assessing condition
  • selecting a management option

For a detailed table: CLICK HERE

Tips and Rules

  • A patient will still be deemed outpatient until inpatient admission occurs. For E&M service provided with inpatient status use- 99234-99236.
  • New vs. Established Patient- A new patient is one that has not been seen or received services from the physician or another physician or healthcare professional of the SAME specialty and subspecialty who belongs to the same group practice within the past three years.
  • When a NP, PA or other advanced care practitioner is seeing or working with a patient and are working with a physician(s), they are considered as though they are working in the SAME specialty and subspecialty as the physician.
  • In both the 2019 Fiscal Year Medicare Physician Fee Schedule and an FAQ dated Nov. 26, 2018, CMS expanded current documentation policy applicable to office/outpatient E/M visits. Starting Jan. 1, 2019, any part of the chief complaint (CC) or history that is recorded in the medical record by ancillary staff or the patient does not need to be re-documented by the billing practitioner. Instead, when the information is already documented, billing practitioners can review the information, update or supplement it as necessary, and indicate in the medical record that they have done so.

For detailed definitions and explanations of the NEW rules and guidelines per the AMA see:
CPT® Evaluation and Management (E/M)  Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99XXX) Code and Guideline Change

In order to help Oncology practices transition, Legion Healthcare Partners will be hosting several specific webinars as well as be offering consulting to help ensure an accurate transition and integration.

The approach and focus will be on the following key areas:

Assessing Financial Impact Ensuring Education and Coding Support
Assisting in Updating Practice Protocols Detail Legal Liabilities
Defining Documentation Accuracy Identifying Operational Impact
Ensuring an Encompassing Compliance Plan Identify the Questions for Your EHR Vendor

Time is the most critical factor, so don’t wait and stay informed

Call to schedule discuss consulting/education today.

Jordan@legionhp.com or 318-537-1509

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