2021 will be here before we know it and with it comes a major overhaul in the Evaluation and Management (E/M) office visit codes. CMS and AMA have teamed up to ensure that physicians and QHPs are spending less time dealing with the administrative burden relating to documentation and more time with patients.
The Changes to E/M Coding
One of the most major change is that time alone may be used to select the E/M code level for an office or other outpatient visit (except for 99211). However, different categories of services use time differently, so it is important to review each category.
The alternative to using Total Time for document selection is Medical Decision Making (MDM). The current CMS Table of Risk is the foundation for the required elements but there are modifications to remove ambiguous terms and concepts and define important terms. There is a focus on the tasks that affect the management of patients.
Another change is the eliminating History and Physical Exam as an element for code selection. While the work of collecting these elements still calculates into the total time or MDM of the visit, it does not alone determine the appropriate code level.
CPT code 99201 is being eliminated since 99201 and 99202 are both straightforward and differentiated by only history and exam elements.
Since time is the primary basis for code selection, there is an additional code to capture time in 15-minute increments when time exceeds the levels in 99205 and 99215. It can only be used with those codes and when time is the basis for code selection,
These are just a few highlights of the changes. To really understand the changes, read this overview of the code and guidelines from AMA.
Things to Watch For
While these changes are a long time coming and should make a positive difference in the way physicians and patients interact, there are some important things organizations need to be aware of.
Coders and auditors will need to change the way they work. No longer will they be simply scanning a chart to ensure the correct elements have been checked. They will need to think about the patient, the problem and the risks to understand how the visit should be coded.
Morbidity and mortality levels will still be driving medical decision making (MDM). Accurate diagnosis coding and level compatibility are critical so providers should avoid non-specific codes and include comorbidities.
Don’t let your providers forget the time spent with the patient needs to be supported by clinical documentation. You cannot simply select the time you spent for coding without the appropriate documentation.
While history and exam are not required for documentation, they are still needed in many cases to make the correct decisions regarding treatment. If you skip these elements, you may miss details that would affect MDM.
Undercoding and overcoding is still a real concern. Auditing and denial monitoring will be critical to ensure no revenue is being left behind. A tool like MDaudit can help you identify coding outliers and focus your efforts on educating those providers or coders that may need some extra attention.
The AMA has 10 great tips to help prepare your practice that we recommend everyone read through.
Learn More
In October we presented a webinar that reviewed the changes, what you should do to prepare and a sneak peek at how MDaudit will accommodate for those changes. You can watch the webinar anytime and download the slides.
