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Learn MoreThe 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.
“This is long overdue, quite honestly,” says Susan Gurzynski-Wells, Senior Product Manager, Reimbursement, at HealthStream. “These two sets of codes [involved] 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.”
In 2021, code 99201 will be eliminated. Also eliminated is the practice of weighting the history and physical exam as an element of code selection. Instead, guidelines require a medically appropriate history and/or examination. So what does that mean in a real-life setting?
“If I present to my doctor’s office with an earache,” Gurzynski-Wells says, “or with a cut on my toe and I’m a diabetic, my history and physical will be different and medically appropriate to my presenting condition, but that history and physical exam will not be counted toward the code selection for my visit.”
That means whatever treatment was medically appropriate to the earache was provided, and in the case of the injured toe, the acute underlying condition was noted alongside the treatment—and that’s where the documentation stops.
“What they are trying to do with this elimination is reduce the administrative burden on documentation and coding; with this change, they don’t have to document that they checked my ears, eyes, respiratory system, GI system, and so on. All that is not needed just to treat an earache.”
The following changes are only for new and established patient visits beginning in 2021, and around codes 99202 through 99215.
Other installments in this series will include:
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.
HealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsThe leadership development program from HealthStream helps mold your high-potential healthcare employees into proven leaders.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceFulfill compliance requirements with a variety of programs and courseware designed to address critical regulatory requirements as well as educate staff to recognize and mitigate risks.
View All ProductsBy increasing your healthcare staff's focus on quality and safety with HealthStream, they can help to reduce medical errors and readmission rates.
View All ProductsLearn about what HealthStream's healthcare policy management software and how it can help aid your organization efforts.
View All ProductsHealthStream's education helps address diversity, equity, and inclusion within your organization, as well as promoting health equity in the communities you serve.
View All ProductsHealthStream offers professional training and education on how to best optimize your reimbursement process within your healthcare organization.
View All ReimbursementTeach your healthcare staff about the revenue cycle and claim management through targeted training and video tools from HealthStream.
View All ProductsLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ResuscitationIn all areas of resuscitation, from neonatal to elderly care, clinical deterioration is a risk that can be avoided with the help of HealthStream's training programs.
View All ProductsHealthStream's EMS Program offers a comprehensive, CAPCE accredited EMS course library that meets National Registry annual recertification.
View All ProductsNurture the skills of your nurses and medical staff to help mold them into effective leaders with development training from HealthStream.
View All ProductsExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentMake sure your clinicians have the support they need to provide competent care with clinical competency training and development from HealthStream.
View All ProductsHealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All ProductsThe suite of healthcare onboarding solutions available from HealthStream aids in nurse retention and improved patient outcomes.
View All ProductsGive your healthcare staff the decision support and skills training they need with the online products available from HealthStream.
View All ProductsHealthStream leverages medical professional development in healthcare by providing staff training programs
View All ProductsLearn more about HealthStream's Provider Credentialing, privileging, & enrollment solutions.
View All CredentialingExperience standardized and centralized healthcare credentialing, privileging, and enrollment that is smarter and faster than ever before.
View All ProductsAutomated, web-based provider credentialing and enrollment software for growing medical groups.
View All ProductsNCQA-certified CVO verification services for initial and re-credentialing files in an overflow or full-service capacity for healthcare organizations.
View All ProductsSearch, review, and add providers into the Epic provider master file with our Epic app integration, Provider Validate.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare scheduling software designed to optimize staffing requirements & elevate patient care
View All ProductsPrecisely align staffing and needed resources to enable efficient patient flow and high-quality, cost-effective patient care.
View All ProductsHealthStream’s free nurse schedule app, NurseGrid™, is built to help you care for your staff and engage with their specific needs.
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