Thursday, February 4, 2021 | Nicole Knight
After a long road of preparing for significant changes to Evaluation and Management (E/M) coding, revised policies on coding, documentation and payment of E/M services are now in effect. According to an American Medical Association (AMA) survey 100% of the major commercial payors said they would adopt new E/M guidelines, which means the changes that went into effect Jan. 1, 2021 have a significant impact on your program’s revenue cycle. It’s not too late to understand the evolution of E/M coding and documentation, and how to set your practice up for success in 2021 and beyond.
How Did We Get Here?
To understand how E/M changes came about, we must revisit the implementation of electronic medical records (EMRs) and travel back several years. Despite many benefits, EMRs forever changed the patient-provider interaction. The number of templates, checkboxes and sometimes burdensome details has resulted in lengthy, eight to 10-page notes lacking relevant details. The introduction of EMRs into the exam room also resulted in some patients feeling disconnected.
In 2018, the Centers for Medicare and Medicaid Services (CMS) released proposed coding changes which were considered flawed, resulting in a collaborative work group with the AMA. The work group developed alternative proposals that CMS included in the 2019 Medicare Physician Fee Schedule (MPFS) final rule. Ultimately, CMS adopted the AMA recommendations for office and outpatient E/M visit codes for calendar year 2021.
The overall goals of these changes are “putting patients over paperwork” aimed at:
What Is the Impact?
On December 2, 2020, the Calendar Year (CY) 2021 MPFS was published in the Federal Registry. However, on December 27, 2020, the Consolidated Appropriations Act, 2021 modified the CY 2021 MPFS. The revised MPFS conversion factor for CY 2021 is $34.8931. Other provisions included:
The table below compares the wRVU and national reimbursement rates from CY 2020 to CY 2021.
The key 2021 E/M revisions and impacts include the following:
Correct CV Documentation Is Key
Document the elements of MDM:
Data element of MDM:
Total visit time:
Why Does it Matter?
The new coding and documentation changes are the first major overhaul to E/M guidelines in nearly 30 years. We are hearing commercial payers are on board with these changes. It is important to remember there is no change to the 1995 and 1997 guidelines for all other E/M visit categories (inpatient admit, observation, discharge, ER, etc.)
MedAxiom ended 2020 offering several education sessions regarding the E/M code changes and the impact on cardiology. We have continued to receive positive feedback from providers on the new guidelines. The AMA simplifying the code selection criteria and making them more clinically relevant and intuitive has eased the adoption of the changes.
Looking ahead, E/M coding will remain a significant part of CV programs. Ongoing provider education, chart reviews and consistent feedback are key to success. Updates to EMR systems that have current E/M calculators will need to be revised and careful attention should be paid to monitoring the changes.
Although all the implications are not definite, it is hoped the changes will improve efficiency while reducing administrative burdens and ultimately improve patient care.
Visit MedAxiom’s Revenue Cycle Solutions Hub for education and resources to help you navigate E/M changes.
As cardiovascular-specific experts, the MedAxiom Revenue Cycle Solutions team is your premier coding, billing and reimbursement resource. Ready to optimize your revenue cycle? Contact us.
Illustration: Lee Sauer
Nicole Knight, LPN, CPC, CCS-P, ACS-CA, is Vice President, Revenue Cycle Solutions and Consulting at MedAxiom. Her decades of hands-on health care experience includes cardiology and neurology practice operations, clinical management, business office management, and consulting for coding and compliance. Nicole maintains her LPN licensure in Louisiana and Florida. She is a member of the American Academy of Professional Coders and the American Health Information Management Association. She received her Advanced Coding Certification with the Board of Medical Specialty Coding. Nicole is a certified AHIMA ICD-10-CM Trainer and completed a Lean Sigma Healthcare training course at Johns Hopkins University. She also serves on the Physician Practice Council for AHIMA.
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