2020 Versus 2021: When Is 99211 Reported? 111 2020 Versus 2021: When Is 99211 Reported? 2020 Versus 2021: When Is 99211 Reported? We have reported that code 99201 (level 1, new patient visit) will be deleted (due to lack of differen­tiation from 99202), but what happens with 99211 (level 1, established patient visit)? The answer is that the changes make the intended use of 99211 clearer. The code descriptor for 99211 is revised to more accurately reflect the service, as shown in the Table. 99211 Code Descriptor Change 2020 2021 99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care profes- sional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services. ▲99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care ­professional. Usually, the presenting problem(s) are minimal. Note that the typical time of 5 minutes is removed from the 2021 descriptor. This aligns with 2020 and 2021 Current Procedural Terminology (CPT ®) guidelines that the time used in code selection for an office E/M service is that of a physician or other qualified health care professional (QHP) and not clinical staff. Because 99211 is typically not performed by a physician or QHP, it was appropriate to remove any reference to time. CPT guidelines for 2021 state the following about 99211: Beginning with CPT 2021 and except for 99211, time alone may be used to select the appropriate code level for the office or other outpatient E/M service codes. For office or other outpatient services, if the physician’s or QHP’s time is spent in the supervision of clinical staff who perform the face-to-face services of the encounter, use 99211. (Note: This is applicable when the physician or QHP does not provide a face-to- face service on the same date.) A minimal problem is defined as a problem that may not require the presence of the physician or QHP, but the service is provided under the physician’s or QHP’s supervision (see 99211). Ped Office-based EM Coding booklet interior.indd 111 Ped Office-based EM Coding booklet interior.indd 111 9/14/20 12:02 PM 9/14/20 12:02 PM
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