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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.


Ships September 2020
ISBN 978-1-64535-054-5

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
Elements to cover:

  • Overview of E/M office codes (importance; historical utilization rates)
  • Background on current changes (AMA documentation updates; CMS approvals)
  • Background on 1995 and 1997 guidelines (development; challenges; a new era)
  • Timeline: Graphic showing timeline of changes


SECTION 1: 2021 DOCUMENTATION GUIDELINES

Elements to cover:

  • Map Out MDM
    • 2021 changes and MDM elements (explanation of three MDM elements
    • New “Level of Medical Decision-Making Table” (what’s new; how it differs from previous MDM table and the “Table of Risk”)
  • Tick-tock Goes Time
    • Revised time standards
    • Standard E/M time (typical time) v Office E/M time
    • What counts
      • Activities
      • Watch for double dipping (compliance §?)
    • How to report E/M codes using time
      • Chart
      • Scenarios
      • Prolonged service code?
    • Split/Shared
  • History and exam (you still need to chart them; here’s what to know)


SECTION 2: 2021 CODING UPDATES

Elements to cover:

  • Coding changes:
    • 99201 deleted (rationale)
    • Revised prolonged service guidance
      • Don’t report 99354-99355 with office E/M codes
      • Don’t report 99358-99359 with office/EM codes
      • “For prolonged services on a date other than the date of a face-to-face encounter, including office or other outpatient services (99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215), see 99358, 99359.”
      • Report 99415-99416 with office E/M, but not w/99xxxx
  • New code: 99xxx Prolonged services (used with Level 5 E/M codes)
    • Do not report 99XXX in conjunction with 99354, 99355, 99358, 99359, 99415, 99416
    • “For prolonged time without direct patient contact on the date of office or other outpatient services, use 99XXX.”
    • Calculate time for 99205, 99215 – at least 15 minutes
      • charts
    • Scenarios appropriate, inappropriate use
    • CMS rules (limits)
  • New code: Primary care add-on
    • CMS code see PFS
    • Scenarios appropriate, inappropriate use
  • Deleted prolonged service codes


SECTION 3: INTERNAL COMPLIANCE

Elements to cover:

  • Compliance risks – upcoding, double-dipping, documentation gaps
  • Working with vendors and updating templates (Don’t forget!)
    • What needs to be revised
      • Paper
      • Electronic
  • How to deal with other payers (privates/workers’ comp)
    • If anyone is doing anything other than following CPT or CMS, what is it?
  • Key timelines (Prepare for first internal audit; next steps)


SECTION 4: 2021 PAYMENT UPDATES
Elements to cover:

  • 2021 pay outlook for 99202-99215 (proposed RUC rates; expected specialty impact)
  • Specialty-specific utilization and payment data (chart/graphic heavy section)


SECTION 5: DOCUMENTATION SCENARIOS
Elements to cover:

  • 6 scenarios per level of service showing how to document under 2021 standards:
    • 99202 scenarios
    • 99203 scenarios
    • 99204 scenarios
    • 99205 scenarios
    • 99211 scenarios
    • 99212 scenarios
    • 99213 scenarios
    • 99214 scenarios
    • 99215 scenarios
  • Include at least one compare-and-contrast scenario under each level of service showing how to document under 2021 guidelines vs. 2020 guidelines

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