E&M Coding Changes- What You Need to Know



Very Important Updates for

NextGen Office and Medisoft


Changes to office and outpatient evaluation management (E/M) codes will take effect on Jan. 1, 2021. The old system relied on documentation of a series of bullet points for History, Exam and Medical Decision Making to support a level of service. The new system for 2021 relies on documentation of medically necessary history/exam plus medical decision making or time. As of August 2020, these changes only affect Medicare. 

What do these changes mean for you?

These historic revisions will change the way physician’s document visits. The primary objectives of these revisions were: to decrease administrative burden of documentation and coding as well as decrease the need for audits, through the addition and expansion of key definitions and guidelines. These changes lessen the need for unnecessary documentation in the medical record that may not be pertinent to the patient’s care. These E/M coding changes ensure that payment for E/M is resource-based and that there is no direct goal for payment redistribution between specialties.

Under the new changes, physicians can either choose to document based on Medical Decision Making (MDM) or Total Time. The three MDM sub-components changes provide extensive edits to the elements for code selection and revised/created numerous clarifying definitions in the E/M guidelines.

The definition of time is minimum time, not typical time, and represents total physician/qualified health care professional (QHP) time on the date of service. The use of date-of-service time builds on the movement over the last several years by Medicare to better recognize the work involved in non-face-to-face services like care coordination. These definitions only apply when code selection is primarily based on time and not MDM.

To learn more about some of these coding changes, click here for our full presentation. It provides a deeper dive into what the E&M coding changes are and how they will affect your practice.



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