Beginning January 1, 2021, coding for “Evaluation and Management” (E/M) is changing. These are some of the biggest changes in the past 20 years.
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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