Evaluation and Management (E/M) Coding Changes Take Effect January 1, 2021
Evaluation and Management Coding procedures have not changed since 1997. Chiropractors use E/M coding to describe the work of initial visits, new condition and injury workups, and periodic re-evaluations. While evaluation and management is not the primary code used every visit, as with most allopathic physicians, chiropractors must understand these important coding rules. Incorrect or haphazard coding of these services can lead to fraud, waste, and abuse allegations.
Let’s get it right! We have an opportunity for a “do-over” on these codes. If you never enjoyed a mastery of the E/M coding rules up to now, learn this new way from scratch. Confidence in coding for both providers and CAs brings peace of mind.
We have been preparing all year for the inevitable start date in January, and now is the time to learn how the coding changes affect you!
Most Significant Changes
The documentation of medical necessity required to establish an episode of care hasn’t changed at all. Your obligation to properly justify the assessment, diagnosis, and treatment plan based on history and examination is the same. However, no longer are the elements of history and examination counted to define the level performed to select a code. It’s considered a “given” that history and examination are present in the health record, but they are not considered in selecting a code.
- The new process allows you to choose your E/M code in one of two ways:
- Using the elements of Medical Decision Making (MDM), or
- Total face-to-face, and non-face-to-face time spent by the provider on the date of the encounter
- CPT code 99201 has been deleted and is not in use as of January 2021. The code was deleted because the MDM for both 99201 and 99202 is considered “straightforward” and therefore, there is no need for a code below level 99202. NOTE: If you have been inappropriately using the 99201 as a workaround for new patient visits for cash patients, please stop this now. If discounting for cash is important to you in the new year, check in with us to talk about how ChiroHealthUSA may be the answer.
E/M Coding Based on Medical Decision Making
The medical decision-making elements of E/M coding are not new. The components have been a part of your coding for decades. Now, they move into the forefront as one of the options of primary consideration for describing the work of the visit. The level of code is calculated by:
- Number and complexity of problems addressed at the encounter
- Amount and/or complexity of data to be reviewed and analyzed
- Risk of complications and/or morbidity and mortality of patient management
The more complicated the circumstances, the higher the code. It benefits providers to understand the process so that you can make informed decisions about the level of the problem, etc. There are a dozen clarifying definitions to be mastered. Take the time to make this your own.
Coding Based on Total Time
Through the end of 2020, using the time override in E/M coding was a rare occurrence in a typical chiropractic office. The use of time only applied if the face-to-face time in the encounter included counseling and coordination of care for 50% of the visit. Now, time is one of the two options for standard E/M coding. The total time of the visit, including while face-to-face, and on the same day but not patient-facing is totaled and coded according to the time spent. The types of activities that may count toward time include:
- Reviewing tests and diagnostics in preparation for a patient visit
- Obtaining and/or reviewing separately obtained history
- Performing a medically appropriate examination and/or evaluation
- Counseling and educating the patient, family, or caregiver
- Ordering tests or procedures
- Documenting the visit in the health record
Become Proficient at Both Methods
Your coding choices are not limited to one way or the other. Once you fully understand the mechanics of coding E/M services both ways, with MDM and with time, you can choose which makes the most sense on a patient-by-patient basis. Each E/M service can stand alone and be coded according to the provider’s judgment. Therefore, we hope you will invest a little time in really becoming an E/M coding authority. Once you become proficient in this new coding methodology, it opens the door to improved documentation and understanding of compliance.
- Did you catch our “What’s Happening at the KMC University Helpdesk?” video about the E/M codes? If not, click this link or watch the video on the right side of this page!
- If you missed our in-depth training webinar this month, in which I took a deep dive into the details of the new E/M coding rules, complete with case examples, it’s still available for purchase in the KMCU store.
If you need help, please reach out. Our certified specialists stand ready to assist with this transition or to proactively review your coding and documentation to make sure you are on the right track. We insist on accuracy for your protection!
Kathy Mills Chang is a Certified Medical Compliance Specialist (MCS-P), Certified Chiropractic Professional Coder (CCPC), and Certified Clinical Chiropractic Assistant (CCCA). Since 1983, she has been providing chiropractors with reimbursement and compliance training, advice, and tools to improve the financial performance of their practices. Kathy leads the team of KMC University specialists and is known as one of our profession’s foremost experts on Medicare, documentation and CA development. Kathy or any of her team members can be reached at (855) 832-6562 or info@KMCUniversity.com