E/M Documentation Guidelines, 2021 to Present

Getting paid for some of the most routine outpatient office visits became a new challenge on Jan. 1, 2021, when guideline and code descriptor changes for E/M services — previously announced by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) — take effect.

Specifically, office or other outpatient E/M codes 99202 through 99215 are being updated along with the elimination of code 99201 (due to low utilization).

Most importantly, the methods of selecting code levels via medical decision making (MDM) will change along with the codes. To help make sense of this signficant update for these codes, MGMA has assembled a downloadable tool to outline:

• The level(s) of each E/M code
• The time elements for each code
• Details on the number and complexity of problems addressed to help establish MDM
• The three categories addressing amount and/or complexity of data to review and analyze
• Risk levels for complications and/or morbidity or mortality of patient management.

This resource is part of the 2022 Medical Coding, Billing and Auditing Toolkit.

Additional resources

• "Preparing your practice for 2021 E/M changes" (MGMA Connection)
• "ICD-10-CM updates for 2021, effective Oct. 1, 2020" (MGMA Insights)
• AMA code and guideline changes for outpatient E/M visits (PDF)

Learn more

• MGMA Consulting — Get an organizational tune-up with the help of our MGMA Consultants.
• MGMA Chart Audit Services — Our team of coders employs more than 35 years of institutional knowledge of coding to create personalized experiences that not only teach but lead your team through practices of establishing accurate coding.