On January 1, 2021, significant changes to the office and outpatient Evaluation and Management (E&M) services Current Procedural Terminology (CPT ®) codes (99202-99215) will go into effect. Practices, physicians, and staff must prepare in advance for these changes to ensure a successful transition and avoid any disruption in reimbursement, but it can be difficult to know where to begin.
To help the oncology community during this transition, American Society of Clinical Oncology (ASCO) has prepared a set of tools, and continues to develop educational materials, that explain the coming changes. For example, ASCO identified nine essential tips to help oncology practices ensure they’re prepare for the changes. The nine tips start with becoming familiar with what will change and providing guidance for coordinating practice staff through the transition, and end by offering the Society’s support to help members through any challenges.
In addition to an overview of the changes, ASCO is developing tip sheets with specific guidance on the changes. The first three are available now:
- Selecting a Code Based on Medical Decision Making in 2021—Medical decision making is currently part of the E&M selection components. However, changes have been made to the key elements of medical decision making and the criteria for selection, which are described in a new medical decision making table.
- 2021 Evaluation and Management Changes: Selecting a Code Based on Time—Starting January 1, providers may select the level of office and outpatient E&M services based on either time or medical decision making. In 2021, the definition of time will be based on the total time (face-to-face and non-face-to-face) spent by a physician/qualified health care professional on the day of the encounter. The current time-related rule requiring 50% of the visit be spent on counseling and/or coordination of care to report the service based on time will no longer be applicable.
- 2021 Evaluation and Management Changes: New Prolonged Services Code—Also starting January 1, a new prolonged services CPT ® code will available. The code reflects a “prolonged office or other E&M service that requires at least 15 minutes or more of total time either with OR without direct patient contact on the date of the primary E&M service (either CPT® codes 99205 or 99215).”
More tip sheets are currently in development, along with webinars that will provide an overview of the changes and details about selecting a code based on time, medical decision making, and the prolonged services code.