The Ugly Truth About the New 2021 E/M Changes

2021 Evaluation and Management (E/M) guidelines is one of the biggest changes to physician billing and coding.

One of the biggest changes to physician billing and coding started three months ago with the much-anticipated 2021 Evaluation and Management (E/M) guidelines.

Now that we are past the honeymoon phase, how is it going? Are the benefits of the Patients over Paperwork initiative outweighing the hassle?

From interaction with our client physician groups, the new guidelines have brought both good and bad.

First, the good: Physicians are delighted with no longer feeling the burden of review of systems and comprehensive exams, particularly for new patients.

They feel less pressure to collect data that was not helpful clinically to satisfy documentation requirements.

One urology group invested much time restructuring their patient flow process and the medical assistant’s work by eliminating collecting a complete review of systems and verifying past medical, family, and social histories at every visit. Removing these requirements freed their time for faster response to patient refill requests and medical questions. They also streamlined the use of a history questionnaire only for new patients to the group, much to the delight of their established patients.

Many physicians perceive the new guidelines as an affirmation that CMS and the AMA listened to their frustrations with past documentation requirements. After a year of Covid stress and telehealth, simplifying office E/M coding was a welcomed development.

But with the good often comes the bad.

We work with a sizeable hospital-employed group that has decided not to make any changes to their EMR templates, patient flow, or education. They do not have the capacity within the organization to handle template or process changes, and the individual physicians are focused on what they consider more pressing matters.

While we have encouraged them to enjoy some of the efficiencies the new guidelines provide, they are understandably tired from the past year of stress and change, so they resist thinking about more changes.

During the first quarter of 2021, several groups noted the shift in E/M coding to higher levels, creating excitement and fear. Indeed, to generate additional legitimate revenue by more accurately documenting and coding is always welcomed. Still, for some, the increase has been solely on the folklore that most E/M visits can be coded level four with the appropriate documentation, thanks to the new guidelines. Of course, there are problems with this approach without a complete understanding of the guidelines and a hefty dose of common sense.

While the new guidelines have simplified the assignment of office-based E/M codes, there continues to be some confusion surrounding the new codes. Recently, on March 9th, 2021, the AMA published technical clarifications to the guidelines to clarify the gray areas. While these changes affected physicians, they also affected coding teams struggling with the transition from counting static documentation elements and “bullets” to the nuances of medical necessity and clinical judgment. Adapting is going to take time.Overall, our clients received the new E/M guidelines as good news, even if they have not yet adjusted. Our approach in education continues to focus on working smarter, not harder and shifting the energy spent from including required superfluous history and exam elements to concisely describing the clinical picture and the foundation to coding based on Medical Decision Making (MDM). As with all new things, you need time and patience to adjust, and ultimately, we are hopeful these changes can be beneficial to all physicians.

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