Is your eye care practice ready for the changes to E&M codes?

 

For the first time since their introduction in 1992, the Evaluation and Management (E&M) codes have been revised, and the changes went into effect on January 1, 2021. Before we dive deeper to understand these changes and how they’ll impact you, let first understand the basics.

 

What is Evaluation and Management (e/m)?

Evaluation and management (E&M) services are a category of CPT codes and are used for medical billing purposes. Most of the patient visits require an E/M code. There are different levels of E&M codes, which are determined by the complexity of the patient visit and documentation requirements. Established in 1995 and revised in 1997, these codes have not changed in over 20 years.

 

Why were the changes needed?

Made by the American Medical Association CPT Editorial Panel and others, these changes are in response to the Centers for Medicare & Medicaid’s (CMS) request to collapse the E&M codes and lessen the record-keeping burden on practitioners. There are four critical objectives behind these revisions:

 

• Reduce the admin challenges caused by extensive and unnecessary documentation.

• Promote coding consistency.

• Reduce the need for quality audits by adding more details to CPT codes.

• Ensure resource-based E&M payment and eliminate payment redistribution between specialties.

 

What is changing?

The previous code calculations have been changed or removed altogether. After January 1, 2021, the E&M codes are being calculated based on either total time spent or the level of medical decision-making (MDM).

 

Deleting code 99201: Due to low use of the level 1 code for outpatient visits, this code has been deleted. You can use 99202 to report a new patient visit.

 

Deleting unclear terms/concepts: Terms like “mild” are being removed, and concepts like “acute chronic illness with systematic symptoms” will be clarified.

 

Changes to History and Exam: Although History and Exam are critical factors when reporting the patient visit, they’re no longer key factors in the outpatient E&M code selection. You are now required to document the level of visit you are reporting.

 

Changes in time criteria: Time criteria for E&M codes 99202–99215 have been changed from “typical” to “minimum” and represents total qualified healthcare professional (QHP) time on the date of service. You no longer need to establish how much time was spent on counseling and coordinating on the day of the encounter. 

 

MDM guidelines revised: The guidelines for MDM are being revised. The three core elements will be – Number and complexity of problems, the complexity/amount of data to be reviewed, and the risk of complications/morbidity and mortality of patient management.

 

How will these changes help you?

These changes would be good news for you if you were tired of counting bullet points to assign an E&M level for an outpatient office visit. In the revised process, you’ll be selecting an E&M code based on the total time spent on the date of the encounter with the patient or MDM, whichever is financially beneficial.

 

As stated earlier, these changes will help reduce the admin burden on your team, eliminate coding-related ambiguity, and increase flexibility for your staff members so they can focus more on patient care.

 

Is your ophthalmology practice ready for these changes?

Though the new requirements are not much different from the previous methodologies, they still warrant your attention. It might take your coders a lot of time to understand the changes and code outpatient services correctly, leading to billing backlogs and incorrect billing, causing you to lose revenue. 

 

Billing experts at Alta Medical Management can help reduce your staff’s admin burden and keep your revenue stream flowing. With our efficient coding and billing services, we will help you understand the impact of these changes on your practice so you can start 2021 off on the right foot and maximize your reimbursements.

Schedule a consultation with one of our billing experts:

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