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2021 E/M Coding Update

  • Rachel Tate, DO
13 November 2019

As a rheumatologist, I pride myself on being an advocate for my patients, but I'm not always an advocate for my profession or myself. Should rheumatologists be involved in policy? Should we be political? 

I attended the CSRO legislative update at #ACR19 and wanted to shed some light on a hot topic: the 2021 update to the E/M coding from CMS.

Beginning in 2021, CMS will implement payment, coding, and additional documentation changes for E/M office/outpatient visits, specifically: 

- For level 2 through 5 visits, we will still have the choice to document using the current framework, MDM (medical decision making) or time.  

- There will be a single rate for levels 2 through 4 for new and established patient visits

- When using current framework or MDM to document, for level 2 through 4 visits CMS will only require the supporting documentation currently associated with level 2 visits.     

- E/M level 5 will remain separate to account for higher complexity

- In addition: there will be add-on codes for level 2 through 4 visits that "describe the additional resources inherent in visits for primary care and particular kinds of nonprocedural specialized medical care." 

- Also there will be a new “extended visit” add-on code for level 2 through 4 visits which can also be used to account for additional time spent with patients. 

Of note, the details of these additional codes have yet to be fully fleshed out. Effectively, we need to push for clarity on this coding!

Ultimately, this will lead to an aggregate of +15% for all care in rheumatology based on E/M coding. While the details are still fuzzy, this is an important change for rheumatologists. The CSRO envisions total transparency to best understand how we can use these future codes to care for our patients, so please tune in to, and for further information and get involved!