Are you prepared for Medical Billing Services in 2021?

With COVID-19 into play, it has had been a great hardship for most practices to keep intact with medical billing and constantly changing medical codes. Additionally, the recently varying rules between insurers have added more burden and confusion on healthcare providers. Keeping the coding complications apart, looking ahead to 2021, there can be some significant changes in E/M coding, which are explained in this blog clearly.

You can set strategies of your medical practice planned from now on, so you can speed up on these changes and think of implementing these changes from when they are rolled out.

Changes in CPT codes

So far, CPT codes represented only the level of physical examination and           patient history. From now, it will be completely based on time spent by providers on a patient, especially for office and outpatient services for all types of patients. It can also be the non-applicability of MDM level and the references to both physical and history examinations. Therefore, the need to mention medically appropriate history or a physical exam, along with the required MDM level, will emerge.

MDM plays a crucial role in determining level of service

MDM will be the future key level of coding in 2021 and adapting to this change will definitely require some preparation and work plan. In the current scenario, MDM is considered only as a level of service, whereas from the next year, it will be the sole way of deciding up on the level of service only if you are planning to bill upon time-based.

In line to the new rule to be rolled out, MDM will be based on three conditions:

  • Risk of mortality or complications
  • Addressing problems gauged by complexity and numbers
  • Reviews and analysis based on data quantity or complexity

Time-based billing

At present, physicians might be using time only to choose the level of E/M coding if physicians spend more than 50% with coordinating care and/or counselling during a patient visit. This rule will not work anymore from when the rule is passed in 2021. But it includes both physical and tele visits of patients with physicians on the same day and comprise the following:

  • Educating and counselling patients and to those who are their caretakers as well
  • Care coordination (but not as a separate category)
  • Prescribing tests, procedures, or medications for the patient
  • Documenting clinical information on electronic health records
  • Performing medically appropriate evaluations
  • Referring patients to other additional departments for health investigation
  • Reviewing a history that has been obtained before visiting a practice
  • Evaluating results independently and conveying the same to patients and their caretakers
  • Time taken for preparation before visiting a patient

How to prepare for 2021 medical billing services?

  • Understand as much as you can about the future year changes and keep up your knowledge base with the latest E/M coding changes.
  • See whether you should change electronic health record templates to work with the upcoming changes.
  • Turn your focus towards documenting important information which will be helpful for you to rate the level of MDM service or if opting time-based service.
  • Collaborate with a coding expert who stays well-versed in the upcoming changes.


At 24/7 Medical Billing Services, we excel in offering top notch medical billing and coding services to practices throughout the USA. We stay up-to-date on the latest billing and coding changes and can stand with you by supporting your practice to ease through transitions. We can help you with knowing more about the E/M coding changes of 2021 through our systematic and modernized approach. Talk to us at +1-888-502-0537 for more information.

Read More : A look at the Medical Billing Industry in 2020

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