The American Medical Association (AMA) made 650 CPT (Current Procedural Terminology) code changes in 2013 . The changes are effective with January 1, 2013, dates of service. Of all the new CPT changes, there were 82 Evaluation and Management (E/M) codes in the range 99201-99467. This article describes the changes in the E/M category. Evaluation and Management Services The E/M code changes were in the range 99201-99467. These changes were made to allow a physician or other qualified health care professional to provide services. The revisions clarify that each state’s scope-of-practice laws (not CPT descriptor language) determine the services an individual provider is qualified to perform. For example, the revised descriptor for a level I, new outpatient visit (99201) specifies: Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components:

• A problem focused history;
• A problem focused examination;
• Straightforward medical decision making.

Counseling and/or coordination of care with other physicians, other providers qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self-limited or minor. Physicians typically spend Typically, 10 minutes are spent face-to-face with the patient and/or family. New text (see underlined) allows that counseling and/or coordination of care may be provided by other physicians or “other qualified health care professionals,” and deleted (see strikethrough) text eliminates the reference to “physician” time. Coding requirements are otherwise unchanged. Descriptor changes throughout the E/M chapter of the CPT manual are consistent with the above example. The code descriptors are unchanged but section guidelines have been modified to allow non-physician providers (NPPs) to report services. CPT 2013 also adds 3 new categories of E/M services, for a total of 7 new E/M codes:

There are other changes to CPT codes, stay tuned for future posts to learn about these updates. Listed below are the detailed descriptions of the 7 new E/M codes:

99485 (RVU*=2.19)

Supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient, 24 months of age or younger, includes two-way communication with transport team before transport, at the referring facility and during the transport, including data interpretation and report; first 30 minutes

 99486 (RVU*=1.91)

Supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient, 24 months of age or younger, includes two-way communication with transport team before transport, at the referring facility and during the transport, including data interpretation and report; each additional 30 minutes (List separately in addition to code for primary procedure)

 99487 (RVU*=2.41)

Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified health care professional with no face-to-face visit, per calendar month

 99488 (RVU*=5.4)

Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified health care professional with one face-to-face visit, per calendar month

 99489 (RVU*=1.21)

Complex chronic care coordination services; each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)

 99495 (RVU*=3.96)

Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of at least moderate complexity during the service period Face-to-face visit, within 14 calendar days of discharge

 99496 (RVU*=5.81)

Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of high complexity during the service period Face-to-face visit, within 7 calendar days of discharge

 *Relative Value Unit (RVU) does not reflect Geographic Practice Cost Index (GPCI) nor the Conversion Factor (CF).