E&M Revisions for 2021 Now in Effect

Back in January, revisions to office and outpatient evaluation management (E&M) went into effect. Now, previous code calculations have been changed or removed altogether. With the revisions, codes are now calculated in two ways – time or medical decision making (MDM).1

These E&M revisions were made to reduce the administrative challenges created by documentation and coding, lessen the need for audits by adding more detail to CPT codes to promote coding consistency, eliminate unnecessary documentation that’s not needed for patient care, and ensure that payment for E&M is resource-based and that there’s no direct goal for payment redistribution between specialties.2

In addition, the AMA says the new codes recognize that along with face-to-face services such as examination, counseling and education, non-face-to-face activities are also important and can be billed as E&M services.2 These include care coordination, getting or reviewing separately-obtained history, and ordering medications, tests or procedures.

Last year, we discussed the what and the why behind these updates, as well as some tips on preparing your practice. With these changes now in full swing, you and your team have likely taken the necessary steps to adhere to the coding changes. But if you’re still determining the best ways to adjust, let’s review some of those transition actions from the AMA to consider.3

Lean on Your Team

You don’t have to take on this full transition by yourself. Get your team involved to help or even name one or two team leads to manage. Have them fully educate themselves on the changes, review your procedures, understand your current financial tracking, etc. This is also a great chance to delegate some responsibility and help your team grow.

It’s Not Too Late to Prep

Even if you’re behind on adapting to these changes, there’s still time to set the right plan. Plan a meeting with your team as a group to discuss the changes and affected areas. This will help you speak to everyone at once rather than having to hold several smaller meetings. And it’ll give your team the opportunity to ask questions and give feedback as a group.

Update Your Compliance

Many practices have a compliance plan to prevent ethical and legal mistakes. If you need help building and implementing a plan, the U.S. Department of Health & Human Services has resources to assist. Make sure it’s consistent with the updated E&M revisions as you transition.

Prepare for Possible Financial Impact

Be prepared for unexpected financial effects of the transition by fully understanding the rules and completing a financial analysis. This can help you identify or anticipate possible increases or decreases in revenue.

You can view the complete E&M checklist from the AMA here. And don’t forget, our team has also put together a webinar with a detailed overview of the changes if needed.

Need additional support with the new E&M revisions? We’re just a quick phone call or click away. Schedule a consultation with one of our practice management experts today!

 

Sources:
1 CPT Evaluation and Management (2019, November 1). Retrieved from https://www.ama-assn.org/practice-management/cpt/cpt-evaluation-and-management
2 CMS Finalizes E/M Coding Changes for 2021 (2020, August). Retrieved from https://healthinfoservice.com/evaluation-management-services-coding/
3 10 tips to prepare your practice for E/M office visit changes (2019, November 19). Retrieved from https://www.ama-assn.org/practice-management/cpt/10-tips-prepare-your-practice-em-office-visit-changes

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