AMA CPT Editorial Panel Issues Draft Updated Evaluation and Management (E/M) Codes

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The AMA CPT Editorial Panel approved draft changes to a series of Evaluation and Management (E/M) service CPT codes at its February 2019 CPT Editorial Panel meeting attended by ISASS representatives.  The changes had been developed by a Joint Workgroup of AMA CPT and AMA RUC members, which held multiple stakeholder calls and meetings across a series of months.  These calls and meetings were attended by ISASS CPT Advisor Dr. James Yue and ISASS Alternate CPT Advisor Dr. Morgan Lorio.  The code change proposals are intended to make it easier to document patient visits and reduce regulatory burden on physician and physician staff.

In the next few weeks, medical societies will be conducting AMA/Specialty Society RVS (Relative Value Scale) Update Committee (RUC) surveys for the physician office visit code set (99202-99215, 99XXX). Components of the Medicare Physician Payment Schedule are physician work, practice expense and professional liability insurance. These surveys help in developing recommended accurate relative values for physician work and direct practice expense to the Centers for Medicare and Medicaid Services.

The CPT documentation guidelines to report office visit codes will undergo extensive revision for implementation in 2021. Code level selection will now either be based solely on medical decision-making or total time on the date of the encounter. The extent of history and physical examination will no longer be an element in the code level selection of office visits. If you are selected to complete this survey, please be sure to read the new CPT guidelines and code descriptors in detail before taking the survey. A link to the survey, with the new guidelines for office visits, will be provided in an email in the coming weeks for those selected to participate.

These recommendations will be provided to CMS for review and possible implementation in the Medicare Physician Fee Schedule for 2020 and 2021.