News: AMA issues checklist for transitioning to 2021 E/M coding guidelines

CDI Strategies - Volume 14, Issue 3

The American Medical Association (AMA) recently published a checklist to help physician practices transition to the new evaluation and management (E/M) coding and documentation guidelines slated to take effect January 2021, JustCoding reported.

In the 2020 Medicare Physician Fee Schedule final rule, CMS implemented extensive updates to the CPT® guidelines for reporting E/M office and outpatient services for 2021. Notable updates include the:

  • Deletion of CPT code 99201 (outpatient E/M visit for a new patient, requiring three components: a problem-focused history, problem-focused examination, and straightforward MDM; typically, 10 minutes are spent face-to-face with the patient and/or family)
  • Introduction of a guideline that allows time to be used as a criterion in code selection
  • Modification of the criteria for medical decision-making

The new guidance also increases total payments for most office codes and revises the work relative value units (RVU) for E/M office visits to match the AMA’s RVU Update Committee revised rates.

To help providers as well as clinical and administrative staff prepare for the changes, the AMA created a checklist that advises practices to: 

  1. Identify a project lead: A project lead can help make the transition to the updated guidelines smoother by educating staff on the changes and the practice’s internal reporting policies.
  2. Schedule team preparation time: Practice leaders will benefit from scheduling time for in-person meetings with physicians, clinical staff, and administrative personnel, to review the E/M changes and address questions.
  3. Update practice protocols: Physician practices will need to update their procedures and protocols to align with the new guidelines. The AMA recommends that practices begin this process earlier rather than later.
  4. Consider coding support: Beginning January 1, 2021, physicians will have to adjust to significant coding changes pertaining solely to the E/M office and outpatient category of codes. Coding staff can educate providers and other non-coding staff on the changes.
  5. Be aware of medical malpractice liability: Although the 2021 guidelines should lessen documentation requirements for E/M office visits, physicians should continue to carefully document their work to protect themselves from medical malpractice suits, AMA advises.
  6. Guard against fraud and abuse law infractions: Physicians should continue to take steps to prevent inadvertent overbilling.
  7. Update your compliance plan: As practices undergo the transition to the new E/M guidance, they must ensure that protocols and procedures remain consistent with their current compliance plans.
  8. Check with their electronic health record (EHR) vendor: Practices should contact their EHR vendor to confirm their schedule for implementing the E/M office visit code changes.
  9. Assess financial impact: Practices can perform prospective financial analyses to prepare for potential increases or decreases in revenue as a result of the E/M changes.
  10. Understand additional employer, payer, medical liability coverage requirements: Payers may still require clinical documentation above and beyond the new E/M office visit coding guidelines.

Healthcare professionals can find additional information on these action items and a summary of the E/M changes on the AMA’s website.

Editor’s note: This article was originally published by JustCoding. For other ACDIS articles related to E/M documentation and coding, click here or here.