2021 EM Guidelines: Only for Medicare?

Question:

I work with a surgeon and we see just a few Medicare patients. The surgeon believes the revised 2021 E/M guidelines will not impact our office practice because of our low Medicare volume.

Is this correct?

Answer:

This is not correct and is a common misconception. The revised documentation requirements come from the American Medical Association (AMA) for CPT™. These are the folks that write the codes, not a specific payor.

The changes were essentially agreed to by the Center for Medicare and Medicaid Services (CMS), but they are changes to the code descriptors and guidelines in CPT. One of the primary goals of the change, other than simplification, is standardization. We know that commercial payors and CMS have a variety of documentation standards to support a level of E/M service. Beginning in January 1, 2021, CPT™ has standardized the documentation of the specific level of new and established outpatient visit, which should be applicable to all commercial and government payors.

*This response is based on the best information available as of 04/7/22.