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CMS E/M Coding Changes Developed with American Medical Association (AMA)

April 1, 2021
April 1, 2021

The Blog post is the next of a series of excerpts from HealthStream’s article, Simplified & Streamlined Healthcare Coding: Coders and Physicians eagerly await E/M coding changes arriving in January 2021.

The E/M coding evolution was crafted in tandem with an American Medical Association (AMA) editorial panel, which created a workgroup to review the reporting guidelines and code descriptors for these codes. On February 9, 2019, the panel approved revisions to the CPT E/M office or other outpatient visit reporting guidelines and code descriptors (Cobuzzi, 2020).The AMA sums it up by noting that “The new evaluation and management (E/M) office visit code-selection criteria remove complex counting systems for history, exam, and data that sometimes varied by payer. Physicians can decide whether to code by the total time—including nonpatient-facing activities on the day of service, or medical decision-making related to the visit. In addition, ambiguous terms, such as “mild” were removed and previously ambiguous concepts such as “acute or chronic illness with systemic symptoms” were clearly defined” (Robeznieks, 2018).

Giving Physicians Back Some of Their Time

Adding time back into physicians’ days was a focus for the review team, which reported that these changes could shorten a patient visit by just over two minutes, giving a doctor who sees 20 patients on an average day about 42 minutes back. That alone is a significant reason to adopt the changes, notes Susan Gurzynski-Wells, Senior Product Manager, Reimbursement, at HealthStream.

“This is long overdue, quite honestly,” Gurzynski-Wells says. “These two sets of codes are used for physician office billing, for new and established patients. The code level is assigned depending on the complexity of the visit. Coders/Clinician often use a “Leveling” tool in order to mark how detailed the visit was by reviewing the patient documentation, checking the boxes as they relate to the key components of History, Exam, and MDM. Documentation can now align with patient care and not checking boxes.”

Making Patient Care Needs, Not Reimbursement, a Priority

What CMS has done is take a look at all that work, which involved highest and lowest common denominators, and ask if it was really necessary for patient care, or if it was just being done for reimbursement purposes? The AMA took that notion and went with it, and said for now, it would recommend some changes for the strictly outpatient series of codes, those used in the physicians’ office by the doctor or other qualified healthcare professional who might be reporting services.

References

Cobuzzi, B. (n.d.). AMA on Evaluation and Management Guidelines for 2021. Retrieved July 28, 2020, from https://www.aapc.com/ blog/47400-ama-on-evaluation-and-management-guidelines/
Robeznieks, A. (2018, November 10). E/M prep: Avoid these pitfalls in move to new office-visit codes. Retrieved July 28, 2020, from https://www. ama-assn.org/practice-management/cpt/em-prep-avoid-these-pitfalls-move-new-office-visit-codes

Future installments in this series will include:

  • The Patients Over Paperwork (POP) Initiative
  • An Overview of E/M Coding Changes
  • Audit Reduction, Another Benefit of E/M Coding Changes

Download the full article, Simplified & Streamlined Healthcare Coding, here.

New HealthStream Coursework Coming for E/M Coders

Starting in September 2020, HealthStream and our partner nThrive will release updated educational and training materials around the E/M coding changes. Learn how HealthStream and nThrive can help with solutions to your coding needs and other revenue cycle challenges.