2022 Gastroenterology Reimbursement and Coding Update: Concrete Solutions to Strengthen Your Foundation in GI Coding and Billing (On-Demand) | 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 the Evaluation & Management (E&M) guidelines for 2021. The changes are specific to Office or Other Outpatient Services codes (99201-99205 and 99211-99215). Some of the key changes include the deletion of code 99201, new guidelines specific to codes 99202-99215, changes in component scoring, changes to the medical decision-making table, and changes to the typical times associated with each E/M code.<br /><br />The document explains that the complexity of problems addressed at an encounter is one element used in selecting the level of office or outpatient services. It clarifies that multiple new or established conditions may be addressed at the same time and can affect the medical decision-making (MDM) level. It also states that comorbidities are not considered unless they are addressed and increase the complexity of data reviewed or the risk of complications.<br /><br />The document provides examples of the complexity levels for problems addressed, including self-limited or minor problems for the straightforward level, stable chronic illnesses or acute uncomplicated illnesses for the low level, chronic illnesses with exacerbation or undiagnosed new problems for the moderate level, and chronic illnesses with severe exacerbation or acute or chronic illnesses posing a threat to life for the high level.<br /><br />The document also explains the amount and/or complexity of data reviewed and ordered. It defines terms such as tests, unique tests, external records, independent historians, and independent interpretation. It provides examples of the amount and/or complexity of data for each level of complexity.<br /><br />Finally, the document emphasizes the importance of documenting all relevant information in the HPI, impression, and plan sections of the patient's record. It also highlights the significance of listing all conditions managed or addressed to support the level of service, medical necessity, and preauthorization of tests and procedures.<br /><br />Overall, this document provides a comprehensive overview of the E&M guideline changes for 2021, including examples and practice pearls to ensure accurate coding and documentation.

Keywords

E&M guidelines

2021 changes

Office or Other Outpatient Services codes

component scoring

medical decision-making table

typical times

complexity of problems

comorbidities

amount and/or complexity of data

coding and documentation