New Evaluation and Management (E/M) codes are coming in 2021 –this could simplify documentation.
Here’s an excerpt:
1.Elimination of history and physical as elements for code selection
2. Choice of using medical decision making (MDM) or total time as the basis of E/M level documentation
MDM. While there will still be three MDM subcomponents (number/complexity of problems, data, and risk), extensive edits were made to the ways in which these elements are defined and tallied.
Time. The definition of time is now minimum time, not typical time or “face-to-face” time. Minimum time represents total physician/qualified health care professional time on the date of service
3. Modification of the criteria for MDM:
Terms. Removed ambiguous terms (e.g., “mild”) and defined previously ambiguous concepts (e.g., “acute or chronic illness with systemic symptoms”).
Definitions. Defined important terms, such as “independent historian.”
Data elements. Re-defined the data elements to move away from simply adding up tasks to focusing on how those tasks affect the management of the patient (e.g., independent interpretation of a test performed by another provider and/or discussion of test interpretation with another physician).
4. Modifier/add-on code): GPC1X can be reported with all levels of E/M office/outpatient codes in which care of a patient’s single, serious, or complex chronic condition is the focus. CMS plans to reimburse GPC1X at 0.33 RVUs (about $12).
“Contact your Electronic Health Records (EHR) vendor to confirm the system your practice uses will be ready to implement the new E/M coding and guidelines changes on Jan. 1, 2021.”
My take: The intent of these changes is logical. The goal of coding is to align the reimbursement with the degree of effort and not simply allow pre-formatted templates justify upcoding. They could lead to simplification of documentation and allow more documentation time for medical decision-making part of the visit.
The average emergency room visit cost $1,389 in 2017, up 176% over the decade. That is the cost of entry for emergency care; it does not include extra charges such as blood tests, IVs, drugs or other treatments…
In 2008, 17% of hospital visits were charged the most expensive code. That surged to 27% of visits in 2017, the report said. The average price for the most expensive code more than doubled from $754 in 2008 to $1,895 in 2017.
Hospitals also increased billings for the second most expensive code, but they billed the three least expensive codes less often compared to a decade ago.