E&M Coding Changes Coming in Jan 2021. Is Your EMR Ready?

1. E&M Coding Changes Coming in Jan 2021. Is Your EMR Ready?

2. Introduction • According to the new guidelines by the American Medical Association (AMA), Evaluation and Management (E/M) coding is going to be much simpler than before. • As of now, all changes are for outpatient codes. However, changes in other E&M Coding are expected to follow. • If you think these are only minor changes and wouldn’t affect your medical practice, you couldn’t be more wrong. • The reason is without accurate Coding for outpatients, and you could have increased denied claims, reduced reimbursements, and so on. www.softwarefinder.com 02

3. Was There a Need For Change? The 2021 E&M coding changes were designed with help from the Centers for Medicare and Medicaid Services (CMS) to: • Reduce the burden of administrative tasks on physicians • Change payments for E&M codes • Streamline documentation requirements • CMS’s initial proposal was to break down office visit E/M levels 2-5 to a single payment. • While it would have provided a modest increase for level 2 and 3 E/M codes, they would have cut reimbursement for the top-level codes by more than 50%. www.softwarefinder.com 03

4. What Are the Fundamental Changes in 2021 E/M Coding? Although there are numerous changes made to the E/M codes, there are a few that stand out. Here are some of the more prominent ones: • Deleting level 1 new patient visit (99201) • Prolonged services (15 minutes) can be reported under 99215 • No time reference in code 99211 • Established new codes 99212-99215 www.softwarefinder.com 04

5. Choosing Between Medical Decision Making (MDM) and Total Time in the E/M Documentations • The MDM still includes only three components: the complexity of the problem, risk, and data. However, extensive edits have been made to the way these elements are defined and tallied. • Redefinition of the concept of time meaning minimum time, not the typical time or “face-to-face” time. www.softwarefinder.com 05

6. Tweaks in the selection criteria for MDM • One of the significant changes made in the criteria for MDM is specificity • Terms that were vague and possibly confusing have been replaced with specific terms and phrases. • For instance, the word ‘mild’ was replaced with ‘acute or chronic”. • Secondly, previously undefined terms, such as “Independent Historian’ were also defined and specified. www.softwarefinder.com 06

7. Are 2021 E/M Coding Changes for Everyone? • Any changes in the 2021 E/M office/outpatient CPT codes for either new or existing patients apply to Medicare, Medicaid, Medicare Advantage Plans, and commercial bodies. • However, E/M of HCPCS codes are only applicable to Medicare, Medicaid, and Medicare Advantage Plans. Commercial payers are not required to accept HCPCS codes. www.softwarefinder.com 07

8. What Can You Do to Prepare for 2021 E/M Coding? • So there you have it, all of the changes that will be made by 2021 E&M Coding. • However, you might be thinking, “How do I plan for these changes?” • Here’s a list of precautions you can take to ensure you stay ahead of the curve. www.softwarefinder.com 08

9. Reach out to your EHR Vendor • Talk with your EHR vendor about their plans for incorporating the changes. • Mainly about how the EHR’s code calculator inculcates time and MDM. • Would the EHR software be able to differentiate between the changed codes and others? www.softwarefinder.com 09

10. Reach out to yourMedical Billing Partner • You may also reach out to your medical billing service provider to determine what they’re doing to facilitate the changes. • Likely, some service providers would still prefer their selection criteria to be based on physical and history. www.softwarefinder.com 10

11. Make sure your staff understands medical necessity • Even if you choose the total time in E/M coding documentation, make sure the time reported is realistic. • Chances are, if a doctor reports 60 minutes for a patient with a concussion, they won’t be able to justify it. www.softwarefinder.com 11

12. Conclusion • Numerous E/M codes for outpatients have been realigned to help remove some of the burdens on physicians. • It also helps streamline lengthy documentation to help clear up your time. • Although these changes can seem scary initially, the change should be better once you get the hang of it. • You have time to plan, prep, educate, and implement effectively, but as time is winding down, you better put pen to paper soon! www.softwarefinder.com 12

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