News: AMA issues checklist for transitioning to 2021 E/M coding guidelines
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:
- 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.
- 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.
- 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.
- 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.
- 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.
- Guard against fraud and abuse law infractions: Physicians should continue to take steps to prevent inadvertent overbilling.
- 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.
- 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.
- 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.
- 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.