Skip To Navigation Skip To Content Skip To Footer
    MGMA Stat
    Home > MGMA Stat > MGMA Stat
    Veronica Bradley
    Veronica Bradley, CPC, CPMA

    The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders, “Is your practice prepared for E/M changes in 2021?” The majority (53%) responded “no,” while 47% said “yes.” 

    The poll was conducted Oct. 6, 2020, with 552 applicable responses.

    Many changes published by the American Medical Association CPT Editorial Panel have largely been adopted by the Centers for Medicare & Medicaid Services (CMS):

    • 99201 will be deleted due to low utilization.
    • Time-based coding will be based on total time the qualified healthcare provider (QHP) utilized. 
    • Documentation of time-based coding will be determined by face-to-face and non-face-to-face activities:
      • Preparing to see the patient (e.g., review of tests, review of previous medical record documentation)
      • Obtaining and/or reviewing separately obtained history
      • Performing a medically appropriate examination and/or evaluation
      • Counseling and educating the patient/family/caregiver
      • Ordering medications, tests, or procedures
      • Referring and communicating with other health care professionals (when not separately reported)
      • Documenting clinical information in the electronic or other health record
      • Independently interpreting results (not separately reported) and communicating results to the patient/family/caregiver
      • Care coordination (not separately reported)
    • The QHP must document total time utilized (e.g., “I spent a total of 15 minutes reviewing patient’s labwork, discussing referral option to specialist, setting up X-rays and discussing diagnoses with patient and spouse).
      • In this example, new patient office visit could be coded at 99202 or established patient office visit as 99212.

    Table 1. Time requirements for new patient and established patient codes 99202-99205, 99211-99215

    Another component of E/M that will reflect significant changes will be medical decision making (MDM), in which three elements help determine code selection:

    1. Number and complexity of problems addressed
    2. Amount and/or complexity of data reviewed and analyzed
    3. Risk of complications and/or morbidity or mortality

    Data will be divided into three categories:

    • Category 1: tests, documents, orders, and review of prior external note(s) from each unique source or independent historian(s) — each unique test, order, or document is counted to meet a threshold number
    • Category 2: independent interpretation of tests not reported separately
    • Category 3: discussion of management or test interpretation with external physician/other qualified health care provider/appropriate source (not reported separately)

    The new MDM table for leveling and code selection is available at

    The changes to E/M services have goals in alignment with various resolutions:

    Table 2. Goals and resolutions for E/M updates


    Our ability at MGMA to provide great resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To be part of this effort, sign up for MGMA Stat and make your voice heard in our weekly polls. Sign up by texting “STAT” to 33550 or visit Polls will be sent to your phone via text message.

    Additional resources:

    Veronica Bradley

    Written By

    Veronica Bradley, CPC, CPMA

    Veronica Bradley, CPC, CPMA, has more than 20 years’ experience in medical coding and auditing in various specialties. She is also well-versed hierarchical condition category and risk adjustment coding. Other areas of expertise include E/M, procedural coding, Medicare reimbursement and other critical factors in coding and auditing. Veronica has worked in private practice, group practices, academic school of medicine and hospitals. Veronica received a bachelor’s degree in health information management and a minor in healthcare administration from Regis University in Denver.

    Explore Related Content

    More MGMA Stats

    Explore Related Topics

    Ask MGMA
    An error has occurred. The page may no longer respond until reloaded. Reload 🗙