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Resolved E/M Updates

Hot off the presses from the AMA on the 2021 EM for Office and Other Outpatient Services
AMA just released revisions to the 2021 Office / Outpatient Evaluation and Management Guidelines to include clarifications such as:
  • Clarifying when reporting a test that is considered, but not selected after shared decision making.
  • Providing a definition of “Analyzed” for reporting tests in the data column.
  • Clarifying the definition of a “unique” test.
  • Clarifying what is meant by “discussion” between physicians, and other qualified health care professionals and patients.
  • Providing a definition of major vs. minor surgery.
  • Clarification around which activities are not counted when reporting time as a key criterion for code level selection.
Revisions are posted on the AMA website with an effective date of Jan 1, 2021.

CPT® Evaluation and Management

On Nov. 1, 2019, the Centers for Medicare and Medicaid Services (CMS) finalized a historic provision in the 2020 Medicare Physician Fee Schedule Final Rule.
www.ama-assn.org www.ama-assn.org
 

Begin to Understand 2021 E/M Guidelines​

www.aapc.com

2021 E/M Guidelines FAQ - May

Get answers to the top 10 questions about coding for office and other outpatient services in 2021. Ever since the release of the new 2021 evaluation and Get answers to the top 10 questions about coding for office and other outpatient E/M services.
www.aapc.com www.aapc.com
 
E/M office visits will now be centered around how physicians think and take care of patients and not on mandatory standards that encouraged copy/paste and checking boxes. Key revisions include:
  1. Elimination of history and physical as elements for code selection.
  2. Allow physicians to choose whether their documentation is based on Medical Decision Making (MDM) or Total Time.
  3. Modifications to the criteria for MDM.
  4. Deletion of CPT code 99201.
  5. Creation of a shorter prolonged services code.

2021 CPT® Evaluation and Management (E/M) Coding Changes |... | CMS.org

Colorado Medical Society, the largest physician-based organization in Colorado.
www.cms.org








Specialty-Specific Resources:​

 

Capture SDOH Using 2021 E/M Guidelines​

EMRs are not the end-all for capturing essential MDM.​

www.aapc.com

Capture SDOH Using 2021 E/M Guidelines

EMRs are not the end-all for capturing essential MDM. As of Jan. 1, 2021, we have been given new evaluation and management (E/M) guidelines for outpatient 2021 evaluation and management (E/M) guidelines for outpatient office and ambulatory services include specific areas of risk such as social...
www.aapc.com www.aapc.com
 
2021 E/M Guidelines FAQ – November

AAPC’s senior VP of products answers more of your questions about coding for office and other outpatient services.

Your Questions Answered

www.aapc.com

2021 E/M Guidelines FAQ – November

AAPC’s senior VP of products answers more of your questions about coding for office and other outpatient services. Ever since the release of the new 2021 AAPC’s senior VP of products answers more of your E/M questions about coding for office and other outpatient services.
www.aapc.com www.aapc.com
 

The Art of Setting E/M Pass Rate Thresholds​


Achieve maximum coding accuracy through goal setting and acting when improvements are needed.

Pass Rate Threshold Defined​

What Is the Industry Doing?​

Review CMS Guidance​

Additional Considerations​

ow to Set Pass Rate Thresholds and Other Parameters​

Ensure Audit Plan Effectiveness​

Audit Pass Rates Need Equal and Opposite Reactions​

www.aapc.com

The Art of Setting E/M Pass Rate Thresholds

Achieve maximum coding accuracy through goal setting and acting when improvements are needed. A common question that I get asked is, “What should I Achieve maximum coding accuracy by setting the right pass rate threshold.
www.aapc.com www.aapc.com
 
E/M tips:

Overview of E&M Changes for Outpatient CPT codes 99202-99215 for 2021
History and exam components — no longer factor into your level of decision-making. Instead, determining a level of service will come down to one of two components: Medical decision-making (MDM) or time.
An overview of the revised MDM
Medical Decision Making: Select the correct level of service for codes 99202—99215 in 2021.
The first element of MDM in 2021 office visits
The 1st (of 3) elements of MDM: number and complexity of problems addressed


MDM 2021 Tip 1 | LSU Healthcare Network | New Orleans Specialty & Primary Care Center

www.lsuhn.com www.lsuhn.com

MDM 2021 Tip 2 | LSU Healthcare Network | New Orleans Specialty & Primary Care Center

www.lsuhn.com www.lsuhn.com

MDM 2021 Tip 3 | LSU Healthcare Network | New Orleans Specialty & Primary Care Center

www.lsuhn.com www.lsuhn.com

MDM 2021 Tip 4 | LSU Healthcare Network | New Orleans Specialty & Primary Care Center

www.lsuhn.com www.lsuhn.com
 

Coding and Billing Guidelines for Emergency Department​

Need to know the difference between physician office E/M & ED E/M?

Learn the 5 levels.

These levels require all the key components.


Emergency Department (ED) Evaluation and Management (E/M) codes are typically reported per day and do not differentiate between new or established patients. There are 5 levels of emergency department services represented by CPT codes 99281 – 99285. The ED codes require all three key components (history, examination and medical decision-making) to be met and documented for the level of service selected.

The level of service billed must be based on the intervention(s) that are performed in relationship to the medical care required by the presenting symptoms and resulting in diagnosis of the patient. Professional codes are based on complexity, performed work, which includes the “cognitive” effort. Facility codes reflects volume and intensity of resources used by the facility to provide care.

Coding and Billing Guidelines for Emergency Department | BCBSND

www.bcbsnd.com www.bcbsnd.com
 

10 E/M Questions Answered​

Labs, NPI, Radiology, Cancer, HPB, ortho & more!

See the answers here:

www.aapc.com

2021 E/M Guidelines FAQ – December

AAPC’s senior VP of products answers more of your questionsabout coding for office and other outpatient services. Ever since the release of the new 2021 Get answers to your questions about E/M guidelines for coding physician services.
www.aapc.com www.aapc.com
 
What were the most common challenges of E/M in 2021.

What were the impacts?

Common Challenges​

Hesitation to Upcode

Hesitation to Think Clinically.

Hesitation to Not Document

Not Documenting Enough

www.aapc.com

Looking Back on 2021 E/M Challenges

Study shows physicians and medical coders are struggling with accuracy rates and other challenges. AAPC Services study shows physicians and medical coders are struggling with accuracy rates using 2021 E/M guidelines.
www.aapc.com www.aapc.com
 
The Same-Day Coding Dilemma: Preventive Medicine Versus E&M Codes.

What are the rules separating preventive medicine and evaluation and management (E&M) coding?

E&M services that are problem-oriented, office, and other outpatient visit codes 99202-99215 (along with the hospital, observation, and consultative encounters) are for patients who present with signs, symptoms, conditions, diagnoses, and/or problems that need to be “addressed” by a physician or qualified healthcare professional, and the reason for the encounter is documented using the patient’s own words.

Preventive medicine codes are meant for the reporting of asymptomatic patients, for risk factor reduction, and to establish care and services; these are largely dependent on the patient’s age and screening test(s) fitting the age of the patient.

icd10monitor.com

Preventive Medicine Versus E&M Codes: The Same-Day Coding Dilemma – MedLearn Publishing

Choosing a proper office visit code can become confusing unless one understands the rules separating preventive medicine and evaluation and management (E&M) coding. -Medlearn Media NPOS Non-patient outcome spending
icd10monitor.com icd10monitor.com
 
Can we expect a provider to care for a patient in a lifesaving event and know the variation of the rules?

Providers don’t always know the payor.

What is the future of E&M services in 2023, as we look at the expansion of 2021 DG into other lines of E&M?

icd10monitor.com

The Past, Present, and Future of E&M Services

Providers are currently stuck with outdated templates, leaving plenty of room for improvement. I thought it might be appropriate to take a “four score and
icd10monitor.com icd10monitor.com
 
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