What You Should Know About E & M Coding Changes

Centers for Medicare and Medicaid (CMS) has announced that it will implement Evaluation and Management (E/M) leveling and pay rates for patient care. This will be applicable from the 1st of January, 2021.

This means that providers need to prepare themselves for some significant changes – changes in coding, payment of E-M services, and documentation. This is why CareCloud hosted a webinar to highlight the necessary changes that every provider and physician should expect.

What is Changing?

One of the most major revisions is the deletion of 99201 code. CMS decided to omit it as most U.S. practices do not use it. However, the codes from 99202-99215 have been revised, and what’s important here is that despite the revision, the complexity of coding levels do not change.

CMS has also proposed some revisions in outpatient visits. This includes two divisions based on an outpatient visit, one for an existing patient and one for a new patient.

  • Existing patient – A provider can only record new updates since the last outpatient visit. This means he or she does not need to re-record previous medical history if it has already been documented by another practitioner.
  • New patient –  Billing providers do not need to re-document complaints or medical history for an outpatient visit if documentation has already been recorded by ancillary staff. However, the billing provider can always review information and make necessary updates.

For providers who want to bill based on time, they must follow the new coding rules and often spend more than 50% of their time on counseling, coordination, and patient care. This time only covers time spent face-to-face on the day of the encounter.

Current Procedural Terminology (CPT) and MDM

The American Medical Association (AMA) has proposed some new CPT code descriptors for the office or other outpatient services, for both new or existing patients. These will be used for time spent on the day of encounter or the level of MDM.

This will likely require all qualified healthcare providers to prepare for MDM conversion. MDM has always specified a level of care service. In 2021, MDM will be based upon the following three categories:

  1. The greater number and complexity of a patient visit, the higher the applicable level of decision making. These complexities range from a minor problem to chronic or fatal illness or injuries.
  2. The amount and/or complexity of data to be reviewed and analyzed, and the communication involved to evaluate a patient. This will include the already existing data in the patient’s medical history such as test reports and prescriptions by the physicians. To understand the complexity of data, information available on AMA’s website will be helpful.
  3. The last category determines the assessment of relative danger of patient management, further categorized to minimal, low, moderate, and high. This category also estimates the risk of complications, morbidity, or mortality.

In Summary

Providers and doctors need to plan everything out beforehand, read and research online about these changes, and start working toward making necessary conversions. 

Want to learn more about E & M Code changes? Check out this recent webinar hosted by CareCloud. Additionally, you can stay ahead of ever-changing healthcare regulations by utilizing CareCloud’s advanced billing rules engine that scrubs claims on the front end and catches errors before they go out. You can also have codes reviewed by a CareCloud billing expert. Click here to learn more

It is important to note that conventional methods of documentation are still required for consultations, emergency rooms, and inpatient visits.

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