New Coding Guidelines for E/M Begin in January 2021

If you thought ICD-10 was a game-changer, just wait until January. That’s the opinion of Pam D’Apuzzo, President of RR Health Strategies. Speaking on this week’s Healthcare Confidential podcast, Pam described the significant changes ahead for providers in terms of coding and documentation for outpatient visits.

The changes will affect every aspect of what providers do and the standards they are held to. The new system places less emphasis on how much history is taken; rather, it emphasizes the level of medical decision making and time spent on patient care and navigation.

For example, counseling and coordination of care no longer must be face-to-face. Instead, the collective time spent by either a physician and/or a qualified healthcare provider like a PA or NP preparing to see the patient, reviewing labs or radiology results, obtaining history from elsewhere, or even counseling or educating the patient or family caregiver, and documenting the visit in the EMR, are all considered in establishing the level of the visit.

At the same time, expect a new, simplified grid for medical decision-making, one that is easier to navigate and more in tune with the real-world environment.

Pam recommends creating templates to prompt providers to fill in the appropriate information in the medical record. And she warns that there is likely to be confusion for providers who see patients both in the office and an inpatient setting such as a hospital or nursing home, where the rules will remain unchanged.

She also warns that the likelihood of audit will be high, as is typical with any major change. Payers will likely make the assumption that not everybody has gotten the new rules right and see an opportunity for recoupment.

Bottom line? If you are a provider, you need a plan as you head in to 2021. Don’t put it off. Educate yourself and your staff now so that you are prepared for the new guidelines to roll out on January 1.

Listen to Pam’s full interview here