Explore E/M Coding Changes in 2024 with Medical Coding Audits - 3Gen Consulting

1. Keeping Up With E/M Coding Changes In 2024: The Value Of Medical Coding Audits Medical coding audits have become increasingly necessary over recent years for various reasons. Medical coding guideline changes occur more frequently than they did in the past, with many providers struggling to stay current. One of the most prominent has been yearly E/M code changes. The result is an increased need for providers to be aware of guidelines and pressure to apply them in their medical coding practices. While many providers are struggling, there is a way to turn that around. A small step that can be made to alleviate this burden is to incorporate medical coding audits and education as part of the organization’s compliance plan. Let’s look at what’s happened and how you can take steps to improve your E/M coding results with medical coding audits.

2. E/M Coding Changes in Recent Years While E/M coding changes aren’t new, the most significant coding guideline and documentation requirement changes came in 2021. 2021 E/M Coding Changes 2021 was a challenging year for E/M coding changes, leaving many physicians' offices struggling to keep up. Things began in 2019, when the Medicare physician fee schedule final rule was released with revisions to the outpatient E/M codes in an effort to reduce administrative burden. The intention was implementation in 2021. These changes were launched to combine visit levels 2-4 and group them under a blended payment rate, on top of other changes springing from a workgroup convened by the American Medical Association (AMA). These include the removal of CPT code 99201 and the history and physical examination elements no longer playing a part in the leveling of an office visit. Medical Decision Making or Time became the only two possible elements that would determine the appropriate E/M code. One result was increased awareness of the importance of medical coding audits. 2022/23 E/M Coding Changes Another set of changes rolled out across 2022 and 2023, still under the goal of reducing administrative burden. While the previous set of revisions covered CPT codes 99201 through 99215 and their corresponding documentation standards and code descriptors, the 2023 changes covered additional codes and descriptors in the form of revisions, consolidations, and deletions. The revisions were intended to align with E/M changes planned for 2023 by CMS. These changes included E/M services including hospital observation care, E/M consultations, and prolonged services. At the individual code level this included deleting hospital observation codes 99217 through 99220 as well as removing “rest home” and “domiciliary” as settings for home care. Barbara Levy, MD and Peter Hollmann MD, outlined the goals of these changes. “Our number one job was to make it simple, practical and clinically relevant – you call that administrative simplification. Our number two goal was to decrease the need for audits or to fight fear. Number three was to

3. decrease the unnecessary documentation that was related to coding and not to clinical care and get rid of the junk.” But the reality has been different. In our work as medical coding auditors, we’re finding that many providers have struggled to keep up with changes and have benefited from medical coding audit services to gauge how well they’ve adapted to the changes. 2024 E/M Coding Changes This year has continued the changes and only increased the role of the medical coding company in guiding providers through the shift. 2024 is a year of fewer changes, but ones that still impact the need for medical coding audit services and provider education. This year is marked by the removal of time ranges from the established and new office/outpatient E/M codes. They are being replaced with a single total time amount, which is determined by the lowest minute count in the range for each code. New wording in the code descriptors now specifies that the time “must be met or exceeded”. One example is code 99202. It previously had a time range of 15-29 minutes, and starting on January 1, 2024, a provider has to meet or exceed 15 minutes of total service time before they can use this code to bill by time. Providers Should Consider Medical Coding Audits While the medical coding guideline changes were created to reduce the administrative burden for practices, annual medical coding audit reviews and education must remain part of the providers’ compliance program. This will ensure that any overcoding (compliance risk) or under coding (missed revenue) that may affect the provider is found promptly and addressed appropriately. A clear sign is whether you’ve struggled with E/M coding or changes to coding guidelines in the past. If you do not routinely perform medical coding and documentation audit reviews, it might be time to consider working with a medical coding company to navigate through the ongoing changes. Additionally, if you’ve performed audits before and have flagged issues like not appending modifiers, overuse of certain modifiers, or improper reporting of certain codes, it’s worth considering that your medical coding team might also have issues with changes to E/M coding practices. Medical coding audits are a good way to determine your baseline and where training and education might be required. To get an even clearer perspective on where you’re starting, self-audits are a powerful form of medical coding audit and a good way to determine how and when to work with a medical coding audit company. Self-audits are a way to review your existing medical coding practices to see how well you align with current rules and regulations. In the case of E/M coding changes, they can also be a

4. tool to prevent loss from improper coding in the future. Not all practices may be comfortable or have the appropriate staffing to implement self-audits. If this is the case you may want to consider working with a medical coding company that has certified professional coders, auditors, and educators. If you think E/M coding changes might be a challenge for your organization, contact us today to discuss what we’ve seen in other organizations and the best way to get you started on better medical coding practices in your organization. Original Source - https://www.3genconsulting.com/keeping-up-with-e-m-coding-changes-in-2024-the-value-of-med ical-coding-audits/