Preparing for 2021 code changes for evaluation and management visits: 7 takeaways

Between differing interpretations of guidelines across payers and different audit tools used by insurers, health systems often face difficulty in standardizing coding for office and outpatient evaluation and management visits. But coding changes coming for these visits, as outlined by CMS in its proposed Physician Fee Schedule for 2021, aim to improve uniformity. 

During a Nov. 4 webinar, hosted by Becker's and sponsored by physician-focused billing and practice management company, abeo and its A/I driven E/M levelling platform, TRUSTEDi10, two nationally recognized industry expert speakers took a closer look at the guideline changes and how they compare to current rules.

Presenters were:

  • Amy Turner, BSN, RN, MMHC, CPC, CHC, CHIAP, director of abeo advisory solutions 
  • Angela Jordan, CPC, CPMS, COBGC, senior clinical documentation improvement consultant with abeo's TRUSTEDi10 

Seven takeaways:

1. Under the rule, the treating physician will still need to document medically appropriate history and/or physical exam, when performed, said Ms. Jordan. However, the history and/or physical exam will not be used to determine the visit's code level.

2. Physicians will determine the visit's code level based on medical decision-making performed, or total time spent performing the service on the day of the visit. According to the rule, if the provider uses time as their selection, they must document a total time that does not include time spent by ancillary clinical staff. 

3. To document medical decision-making for office and other outpatient E/M services, the rule uses the number and complexity of problems addressed during the visit, as well as the risk of complications and/or morbidity or mortality of patient management, Ms. Jordan said. The rule also uses the amount and/or complexity of data to be reviewed and analyzed.

4. When documenting office/outpatient E/M visits under the rule, physicians should view the documentation as a story board, advised Ms. Turner. She said even with the changing guidelines, providers should have continuity with documentation, so it is clear what happened during the visit.  

5. Ms. Jordan said the rule includes clear guidance on when comorbidities or underlying diseases can be counted for medical decision-making and provides definitions for the elements of decision-making. For example, there are guideline definitions under the rule for "test," "external" and "independent historian(s)."

6. Ms. Turner said comorbidities will not be used separately in medical decision-making to determine the visit's code level, unless the physician is addressing those comorbidities, or the presence of comorbidities is changing the complexity of the provider's care.

7. Changes under the rule take effect Jan. 1. 

To listen to the webinar recording, click here. To learn more about abeo and their featured A/I driven E/M levelling platform, click here


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