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Resolved E/M Updates

Great article by Barbara Cobuzzi.

Update from Barb: 12/8/20
Quite a few of my colleagues were asking whether CMS had changed the times associated with office and outpatient services after reading the PFS Final rule based on what they read in tables 21 and 25, on pages 230 and 255 of the PFS Final Rule

I felt that the times in the AMA CPT still stood because the times used in the explanation of prolonged services and that the times in charts 21 and 23 in the final rule were for the calculation of the RVUs. I also felt that that the times were as published in the AMA CPT manual because if they were not, CMS would have created CMS specific G codes just like they did with prolonged services G2112.

But my colleagues kept pushing these charts at me. So, today in the Office Hours call with CMS, I asked them and CMS confirmed that the times that are to be used when selecting an EM based on time are the times found in the AMA CPT Manual. Snap!
 
Effective January 1, 2021, there will be major changes coming to outpatient E/M services:

  • The 99201 level of care will be deleted
  • The extent of the history and exam will no longer affect the level of care
  • Level of care will be driven by time OR by the medical decision-making
  • Time will include face-to-face time and non-face-to-face time on the day of the visit
  • There will be new times assigned to all levels of care for new and established office visits
  • There will be a new methodology for calculating the medical decision-making
  • wRVUs for new and established office visits will be increasing
  • There will be a new G code for primary care and/or medical complexity
  • There will be a new prolonged services code for new and established office visits
 
E&M Audit Tool for Medical Coding
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THIS TOOL HAS BEEN UPDATED FOR 2021!
There are many things you need to consider in order to determine the appropriate E&M code to use. But, it does not need to be as complicated as you may think. Our step-by-step guide will show you the exact steps that you need to take to ensure accurate coding.
This guide will take you through the following questions for each case you try to code:
What is the E/M category/subcategory (location and service type)?
What is the level of history?
What is the exam level?
What is the level of medical decision making?
Is time a dominant factor?
Once you have answered all of the above, you can then determine the final E&M level.
Our easy to use, our E&M Audit Tools will provide you with all you need to know about E&M coding in various settings such as office, hospital, facility or home. It breaks down abbreviations such as CC (chief complaint); ROS (review of systems); and HPI (history of present illness) so you have a more comprehensive understanding of how these E&M codes work and what they mean.
Also included is an audit tool to help you score your E&M notes using this guide.

To download, visit this page.
 
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