To keep our clients informed, this newsletter has aggregated material from sources that include the AMA and the AAOS:
The new guidelines are meant to:
- Reduce administrative burden of documentation and coding.
- Reduce the need for audits, by adding more detail to CPT codes to promote coding consistency.
- Reduce unnecessary documentation that is not needed for patient care.
- Ensure that payment for E/M is resource-based and that there is no direct goal for payment redistribution between specialties.
Some key changes for 2021 are:
- New evaluation and management (E/M) code-selection criteria remove complex counting systems for history, exam and data – that sometimes varied by payer.
- Now, physicians can decide whether to code by the total time OR by medical decision-making related to the visit.
- Medical decision-making is now based on:
- Number and complexity of problems addressed at the encounter.
- Amount and/or complexity of data to be reviewed and analyzed.
- Risk of complications and/or morbidity and mortality of patient management.
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