2023 Gastroenterology Reimbursement and Coding Update (On-Demand) | November 2022-Overview of Office E&M Documentation Guidelines

Pdf Summary

This document provides an overview of the Office E&M Guidelines, presented by Kristin Vaughn, a healthcare consultant and lead auditor. The guidelines pertain to the coding and billing of office or other outpatient services. The changes made to the AMA CPT E/M guidelines specifically affect the codes 99201-99205 and 99211-99215. The changes include the deletion of code 99201, the introduction of 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. Time will no longer be associated with code 99211. The guidelines emphasize that the level of decision making will be based on decision making or total time, rather than history and physical examination. The documentation should include information related to the number and complexity of problems addressed, the amount and complexity of data reviewed, and the risk of complications and/or morbidity or mortality of patient management. The level of risk is based on the probability and consequences of an event, while the level of risk related to patient management criteria is based on the decisions made by the reporting physician or qualified health care professional. The guidelines also include a table that outlines the problems addressed, amount and/or complexity of data, and level of risk associated with each E/M code. Starting from 2021, clinicians can count the time spent on a patient's care, both face-to-face and non-face-to-face, on the day of the visit when reporting E/M services based on time. The document concludes with documentation tips, highlighting the importance of including pertinent information in the history of present illness, impression and plan sections, and ensuring that the history and examination are relevant to the patient's chief complaint.

Asset Subtitle

Kristin Vaughn, CPC, QMC, QMGC, CPMA, ICDCT-CM

Keywords

Office E&M Guidelines

Kristin Vaughn

healthcare consultant

lead auditor

coding

billing

office or other outpatient services

AMA CPT E/M guidelines

codes 99201-99205

codes 99211-99215