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2021 E&M Revisions: The Why Behind the Changes

July 21, 2020

Ashley Buehnerkemper

E&M Summary of Revisions

(Scroll down for webinar) As you may have heard, revisions to office and outpatient evaluation and management (E&M) will take effect January 1, 2021. The 2021 E&M revisions guidelines were created by a workgroup put together by the American Medical Association (AMA). The group also represents the AMA’s Current Procedural Terminology (CPT) Editorial Panel and the AMA/Specialty Society RVS Update Committee (RUC).

For dermatologists and other doctors, this means previous code calculations will be altered in certain ways or removed altogether. With the revisions, codes will be calculated in two ways – time or medical decision making (MDM).

But what’s the reasoning behind these updates? What’s the AMA workgroup aiming to achieve? According to the AMA, there are four main objectives:

  • Reduce the administrative challenges created by documentation and coding.
  • Reduce the need for audits, by adding more detail to CPT codes to promote coding consistency.
  • Reduce unnecessary documentation that’s not needed for patient care.
  • Ensure that payment for E&M is resource-based and that there’s no direct goal for payment redistribution between specialties.

A large part of these goals revolves around reducing the burden for doctors, so they can focus more time on patient care and less time on coding.

In addition to alleviating the documentation burden for doctors, another goal is to remove unnecessary complexity and ambiguity, according to the AMA. With the coding determined by either time or medical decision making, many of the varied, complex counting systems will be eliminated. This includes code calculations for history of present illness, past medical history, past social history and physical exams just to name a few. Though, the AMA workgroup did revise the code descriptors to state providers should perform a “medically-appropriate history and/or examination.” Also, some unclear terms like “mild” will be removed and unclear concepts like “acute chronic illness with systematic symptoms” will be further clarified.

The data portion won’t simply add up tasks anymore, and will instead focus on tasks that affect the management of the patient, such as independent interpretation of tests performed by another provider and/or discussion of test interpretation with an external physician/QHP.

The AMA says the new codes recognize that non-face-to-face activities are important and time spent on the following activities can be billed as E&M services:

  • Reviewing tests to prepare for a patient visit.
  • Doing a medically-necessary exam and/or evaluation.
  • Getting or reviewing separately-obtained history.
  • Counseling and educating the patient, family or caregiver.
  • Ordering medications, tests or procedures.

Even though these revisions will require some adjustment, it appears the AMA is acting in the best interests of doctors by simplifying E&M coding and processes. And with the positive impact it’ll have on doctors’ time and focus, it’s ultimately in the best interests of patients too.

And although we’ve touched on some specifics in this post, we want to give you a more detailed overview of the revisions. That’s why we’ve put together a webinar with a detailed summary. Learn more about the upcoming changes by viewing our webinar below.

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