News: AMA on track to revise E/M codes, set new documentation guidelines
The American Medical Association’s (AMA) current procedural terminology (CPT) editorial panel approved sweeping changes to documentation and code selection guidelines for evaluation and management (E/M) codes. If finalized, the changes will shift the way practices select codes for both office and facility visits as soon as January 2021, according to the Revenue Integrity Insider.
The editorial panel-approved changes include several items that would directly affect physician documentation requirements and how charts are coded:
- Deletion of level 1 office new patient E/M code 99201. Medicare claims for code 99201 represented only 0.15% of all 266 million inpatient E/M claims in 2017, and yet it had a 37% denial rate versus an overall E/M denial rate of 5%.
- Removal of history and exam as key components for selection of the E/M service level. The practitioner would be required to document that these elements were performed in order to report an office visit code.
- Practitioners would select E/M codes based on either the level of medical decision making (MDM) or the total time spent performing the service on the day of the encounter.
- A plan to revise the E/M guidelines into three sections:
- Guidelines common to all E/M services,
- Guidelines specific to office and other outpatient visits, and
- Guidelines specific to E/M services in the facility setting, including observation, hospital inpatient, consultations, emergency department, nursing facility, domiciliary, rest home or custodial care and the home setting.
- Total time would include “total time spent on the day of the encounter,” instead of total face-to-face time.
- A major overhaul of the MDM documentation guidelines to emphasize complexity of the conditions being addressed in place of the number of diagnoses reported.