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.
Published: September 2020
Page count: 194
ISBN: 978-1-64535-054-5
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
- 99202