2025 Gastroenterology Reimbursement and Coding Update (Virtual)

2 -Overview of E&M

Pdf Summary

Edward Sun, MD, delivered a presentation on Evaluation and Management (E&M) Documentation Guidelines, focusing on changes to the 2024 Physician Fee Schedule and the impact on billing practices. The agenda includes an examination of physician fee schedule trends, E&M visit rules, billing by medical decision-making, and billing by time.<br /><br />Key changes involve the Geographic Practice Cost Index (GPCI) and the conversion factor, which impacts payment calculations. The 2025 conversion factor is noted as 32.35, a decrease from 2024. Dr. Sun emphasizes the importance of understanding coding, documentation, and reimbursement rules to adapt to productivity pressures.<br /><br />The presentation highlights significant improvements due to legislation like the Patients Over Paperwork Act of 2021, reducing outpatient and inpatient documentation requirements. The guidelines specify MDM levels—straightforward, low, moderate, and high—based on the number and complexity of problems, data reviewed, and risk of patient management.<br /><br />Dr. Sun outlines the correlation between billing codes and Medical Decision Making (MDM) levels, matched with specific times for new and established patient visits, including initial and subsequent hospital care. Billing by time now accounts for total time spent on the day of the visit, not just face-to-face interaction.<br /><br />E&M codes have distinct RVU values connected to the complexity of service provided. Specific ICD-10 codes related to social determinants of health are also discussed for appropriate documentation to support the level of risk assessment in patient encounters. <br /><br />Dr. Sun provides resources for further guidance, including the ASGE Coding Primer and Medicare Physician Fee Schedule Look-Up Tool, offering contact information for additional support.

Keywords

Evaluation and Management

Physician Fee Schedule

Geographic Practice Cost Index

Medical Decision Making

Patients Over Paperwork Act

ICD-10 codes

RVU values

billing practices

documentation guidelines

reimbursement rules