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Coders and Physicians Eagerly Await E/M Coding Changes Arriving in January 2021

The Blog post is the first 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 Patients Over Paperwork (POP) Initiative continues to realign and restructure healthcare documentation requirements— on January 1, 2021, coders and clinicians who work with evaluation and management (E/M) coding, will see significant and eagerly awaited changes.

THE POP GOALS INCLUDED:

  • Reduce administrative burden around documentation and coding
  • Add and expand key definitions and guidelines, in order to reduce the need for audits
  • Reduce medical-record documentation not needed for patient care
  • Keep payment for E/M resource-based and eliminate the need to redistribute payments between specialties (Cobuzzi, 2020)

The POP initiative, which was enacted by the Centers for Medicare & Medicaid Services (CMS) in 2019, defined cutting red tape and reducing or overhauling outdated regulations as the goal. The E/M changes that fall under it are in response to longstanding provider complaints about having to enter duplicative and sometimes clinically insignificant information into a patient’s medical record to meet coding and billing requirements.

The specific changes to E/M coding, which are the first to come along since the mid-1990s, include continuing to use patient history and exam information as part of the encounter documentation. The three elements of medical decision making (MDM)—complexity of the patient’s presenting problem, data to be reviewed, risk, and time to determine the level of the encounter.

The changes only affect a limited code range from 99202 to 99215 and are for office and outpatient services, which are the codes that represent about 20 percent of Medicare spending (Robeznieks, 2018).

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 genesis of the E/M Coding evolution
  • 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.

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