Code Encounters

2021 CPT E/M Guideline Definitions for Acute and Chronic Illnesses

Acute, uncomplicated illness or injury

Elements

In the past both history and exam have been required for code selection. With the new changes both history and exam will need to be documented but will not affect the code selection. There will be no minimum requirement, beyond establishing medical necessity and the standard of care. Providers will be able to select the E/M service level either by the level of medical decision making or by the total time spent performing the service on the day of the encounter.

Per CMS: they have “established an internal process to evaluate and streamline regulations with a goal to reduce unnecessary burden, to increase efficiencies, and to improve the beneficiary experience. In carrying out this internal process CMS is moving the needle and removing regulatory obstacles that get in the way of providers spending time with patients.”

OIG announced that they reviewed 100 telehealth claims performed in 2014 and 2015. Of the claims they found that 31 did not meet telehealth requirements.

President Trump signed and issued an Executive Order on Improving Rural and Telehealth Access that would expand the telehealth benefits permanently. Physician Fee Schedule Proposed Rule would make some telehealth and workforce flexibilities that were provided since the COVID-19 Public Health Emergency. It also focusing on improving access and convenience of care for Medicare beneficiaries, particularly those living in rural areas. One area the order also addresses is a multi- year effort to reduce clinician burden under Patients over Paperwork Initiative.