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2021 E/M Office Visit Reference Guide

Product Code: EMOVRG

Quick Overview

The 2021 E/M Office Visit Reference Guide delivers a comprehensive overview of the new E/M documentation guidelines and a clear, in-depth analysis of the 2021 changes, including the confusing new medical decision-making (MDM) guidelines so that you can ensure a seamless shift to the new guidelines.
ISBN 978-1-64535-054-5
Pages 194
Publication Date Sep 24, 2020

Price: $169.00

2021 E/M Office Visit Reference Guide

2021 E/M Office Visit Reference Guide

The new 2021 E/M documentation guidelines are set to take effect Jan. 1, 2021, and are expected to create a sea change in how medical practices select a level of E/M service. The revised reporting requirements mark the first significant update in more than 20 years since the release of the 1995 and 1997 documentation guidelines.

The 2021 E/M Office Visit Reference Guide delivers a comprehensive overview of the new E/M documentation guidelines and a clear, in-depth analysis of the 2021 changes, including the confusing new medical decision-making (MDM) guidelines so that you can ensure a seamless shift to the new guidelines.

Use the 2021 E/M Office Visit Reference Guide to train staff, reduce the risk of miscoding and the denials and audits that may result, and lessen the disruption to a key revenue stream. E/M office visits account for 20% of total physician fee schedule charge. In 2018, practices gained $15.6 billion in payments from Medicare for the suite of E/M office visit codes 99201-99215.

Additionally, the 2021 E/M Office Visit Reference Guide will help you:

  • Guarantee a successful and smooth transition to the new system with best practices on how to revise superbills and templates; what to know about working with third-party vendors such as electronic health record (EHR) providers; and how to manage two different E/M systems simultaneously.

  • Ensure your coders are accurately selecting the correct level of service for E/M office visits with office and staff training tips, including separate breakout sections for coders and clinicians; audit safeguards; and more.

  • Train clinicians on the 2021 documentation changes with several dozen documentation scenarios that clearly illustrate how a coder/clinician should accurately select a Level 1, 2, 3, 4 or 5 E/M code. The book will present scenarios tailored to specific specialties.

  • Understand the level of medical decision-making or time for code selection with comprehensive coverage of MDM and time elements.

Table of Contents

Introduction

  • Overview and welcome
  • Background on E/M changes
  • E/M utilization trends
  • E/M payments in review
  • Projected 2021 E/M office visit payment rates
  • Summary of changes
  • Revisions to E/M code descriptions and reporting requirements, 2020 vs. 2021


Section I: 2021 Documentation and Coding Guidelines

  • Make Sense of Medical Decision-Making
    • What is medical decision-making and why is it so important?
    • 2021 MDM update streamlines reporting
    • The 3 columns – what they mean and how to use them
    • Number and complexity of problems addressed: Definitions
    • A closer look at the 4 levels of problems addressed
    • Amount and complexity of data to be reviewed and analyzed
    • Data analysis: A closer look
    • Risk of complications and/or morbidity or mortality of patient management
    • Take the new guidelines out for a spin
    • In summary
  • Time-based Coding for E/M Office Visits
    • Count every minute on the day of the visit
    • Changes to office visit coding
    • Activities that count toward time
    • How to calculate time
    • Split or shared time: When two practitioners see the patient
    • Set terms and times for documentation
  • Prolonged Services and Extended Services
    • Introduction: Prolonged service changes
    • 99417 — When Level 5 office visits max out on time
    • Calculating time: CPT vs. CMS
    • 99415-99416 — When supervised clinical staff perform the service
    • 99358-99359 — When the office visit and prolonged service are different days
    • Understand times, thresholds
    • New work intensity add-on code
    • 99354-99355 — Office visits excluded


Section II: 2021 Compliance and Readiness Updates

  • Address New E/M Compliance Risks
    • General risks
    • MDM-based coding
    • Time-based coding and prolonged services
  • Break the E/M Transition Into 4 Pieces
    • Learn, then train
    • Tackle the paperwork
    • Size up your software
    • Work on workflow
  • Quick-Glance Update Tool
    • E/M transition walkthrough


Section III: 2021 E/M Office Visit Coding Scenarios

  • How to Use the Coding Scenarios
    • Comparison tables
    • Definitions of typical medical abbreviations found in the following office notes
  • Medical Decision-Making Coding Scenarios
    • 99202
      • Scenario #1: 99202—Suture removal
      • Scenario #2: 99202—New concern about a lesion
      • Scenario #3: 99202—Family risk factors for heart disease
      • Scenario #4: 99202—Right foot pain
      • Scenario #5: 99202—Tick bite
    • 99203
      • Scenario #6: 99203—Foreign body in index finger
      • Scenario #7: 99203—Right leg wound
      • Scenario #8: 99203—Abscess on left breast
      • Scenario #9: 99203—Vaginal discharge, vulvar itching, vaginal odor
      • Scenario #10: 99203—Forehead pain, green nasal discharge and fever
    • 99204
      • Scenario #11: 99204—Nausea, vomiting, diarrhea
      • Scenario #12: 99204—Chest pain
      • Scenario #13: 99204—Referral for newly diagnosed right breast cancer
      • Scenario #14: 99204—Left knee pain
      • Scenario #15: 99204—New concern about prostate cancer
    • 99205
      • Scenario #16: 99205—Family history of cardiomyopathy
      • Scenario #17: 99205—Follow up of stroke
      • Scenario #18: 99205—New concern about a lymphocytosis and anemia
      • Scenario #19: 99205—Newly diagnosed stage III colon cancer
      • Scenario #20: 99205—Complex pediatric patient
    • 99211
      • Scenario #21: 99211—Hematoma
      • Scenario #22: 99211—Blood pressure check
      • Scenario #23: 99211—Dressing change
      • Scenario #24: 99211—Urinary tract infection
      • Scenario #25: 99211—Doctor’s note to OK return to daycare
    • 99212
      • Scenario #26: 99212—Procreation counseling
      • Scenario #27: 99212—Skin lesion on shoulder
      • Scenario #28: 99212—Sore throat
      • Scenario #29: 99212—Otitis media follow up
      • Scenario #30: 99212—Skin rash on arm
    • 99213
      • Scenario #31: 99213—Ankle pain and swelling
      • Scenario #32: 99213—Acute upper respiratory infection
      • Scenario #33: 99213—Hemorrhoid follow up
      • Scenario #34: 99213—Repeat bacterial vaginitis
      • Scenario #35: 99213—Pediatric GI virus
    • 99214
      • Scenario #36: 99214—Hypothyroidism and obesity
      • Scenario #37: 99214—Multiple stable chronic illnesses follow up
      • Scenario #38: 99214—CKD and HTN follow up
      • Scenario #39: 99214—Left wrist fracture
      • Scenario #40: 99214—Viral pneumonia
    • 99215
      • Scenario #41: 99215—Brain tumor
      • Scenario #42: 99215—Aplastic anemia
      • Scenario #43: 99215—Myocardial infarction
      • Scenario #44: 99215—Multiple sclerosis
      • Scenario #45: 99215—Metastatic breast cancer
      • Time-based Coding Scenarios
    • 99202
      • Scenario #46: 99202—Right foot pain
      • Scenario #47: 99202—Pain in forehead, green nasal discharge and fever
    • 99203
      • Scenario #48: 99203—Family risk factors for heart disease
      • Scenario #49: 99203—Lesion on shoulder
    • 99204
      • Scenario #50: 99204—Spells of loss of consciousness
    • 99205
      • Scenario #51: 99205 and add-on code 99417—
      • Newly diagnosed stage III colon cancer
      • Scenario #52: 99205 and add-on code 99417—Follow up of stroke
    • 99212
      • Scenario #53: 99212—Note to return to daycare
      • Scenario #54: 99212—Chest pain
      • Scenario #55: 99212—Sore throat
    • 99213
      • Scenario #56: 99213—Lesion on shoulder
      • Scenario #57: 99213—Left wrist pain
    • 99214
      • Scenario #58: 99214—Persistent and worsening cough
    • 99215
      • Scenario #59: 99215 and add-on code 99417—
      • Metastatic breast cancer, clinical trial and sinus pain

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