2021 Medicare Office Outpatient E&M Coding Guidelines

Register now for this online self-guided course.
AVAILABLE IMMEDIATELY!
The Centers for Medicare & Medicaid Services (CMS) announced in the 2019 Final Rule that changes to E&M services would be initiated as an attempt to alleviate the administrative burden the current guidelines presented to providers. The Final Rule established new Evaluation and Management coding guidelines, effective January 1, 2021, that replace the previous 1995 and 1997 guidelines. The CPT coding changes retain 5 levels of coding for established patients, reduce the number of levels to 4 for office/outpatient E/M visits for new patients, and revise the code definitions. The CPT code changes also revise the times and medical decision making process for all of the codes, and requires performance of history and exam only as medically appropriate. The CPT code changes also allow clinicians to choose the E/M visit level based on either medical decision making or time. In addition to the E&M code changes, opportunities for additional services are available to clinicians. CMS recognizes the time and effort clinicians provide to patients with complex conditions by allowing coding and documentation for prolonged services and a patient complexity add-on code.

This class will provide an in depth review of what is changing and why. Participants will learn about the specific options and requirements from coding experts and a clinician. The presenters will provide an explanation of the new methods using pertinent case examples.

Approximate time to complete the course: 2 hours
Learner content includes: videos and a 10 question posttest
Participants will have 45 days from the date of their registration to complete this course. After that date, course materials will no longer be accessible. There is no fee to participate but you must register.

Course Content
Part 1 - Overview, Medical Decision Making Coding, and Time-Based Coding

• What is changing and why? (background/proposed rule)
  
• Resources: potential practice cost savings and reimbursement changes
  
• Medical Decision Making Option: current vs. new
  
• Case Examples – what to document
  
• Time-Based Option: explanation, what is included, and how to document
  
• Case Examples – what to document
  
• Q&A

Part 2 - 2021 Final Rule Review, Add-on Codes, Coding Risks and Audits

• Review final MDM and time-based requirements
  
• Patient Complexity Add-on (GPC1X)
  
• Prolonged Services
  
• Continued Monitoring/Auditing: overview and why this is important
  
• Potential Risks
  *Rationale/documentation to match/support time spent and coded
  *Audit criteria
  
• Potential Workflow Changes: strategies and things to think about