2022 Gastroenterology Reimbursement and Coding Update: Concrete Solutions to Strengthen Your Foundation in GI Coding and Billing | November 2021-02 - E&M 2021 Rev Pt 1 - Complexity of Problems Addressed and Data

02 - E&M 2021 Rev Pt 1 - Complexity of Problems Addressed and Data - Vaughn

Pdf Summary

This document provides an overview of the changes to Evaluation & Management (E&M) guidelines for office or other outpatient services. The changes are specific to codes 99201-99205 and 99211-99215. Some of the key changes include the deletion of code 99201, new guidelines for codes 99202-99215, changes in component scoring for both new and established patient codes, changes to the medical decision-making table, and changes to the typical times associated with each E/M code.<br /><br />The complexity of problems addressed at an encounter is one element used in determining the level of E/M services. Multiple new or established conditions may be addressed at the same time and can affect medical decision-making. Comorbidities are not considered unless they are addressed and increase the complexity of data to be reviewed and analyzed or the risk of complications or morbidity/mortality.<br /><br />Examples are provided for each level of complexity: straightforward, low, moderate, and high. For example, a straightforward problem could be a self-limited or minor problem, while a high complexity problem could be a chronic illness with severe exacerbation or a threat to life or bodily function.<br /><br />The amount and/or complexity of data ordered and reviewed are also important factors in determining the level of E/M services. Examples of data elements include tests, documents, external records or communication, independent interpretation of tests, and discussion of management or test interpretation.<br /><br />The document provides additional details on these elements and offers examples for each level of complexity.<br /><br />In conclusion, understanding the revised E&M guidelines is essential for accurate coding and documentation. The changes specifically impact office or other outpatient services and involve the complexity of problems addressed and the data ordered and reviewed. Training and attention to detail are necessary to ensure compliance with the new guidelines and to appropriately bill for services rendered.

Keywords

Evaluation & Management

E&M guidelines

office or other outpatient services

codes 99201-99205

codes 99211-99215

medical decision-making

component scoring

typical times

complexity of problems

data ordered and reviewed