2027 Gastroenterology Reimbursement and Coding Update (Virtual) | November 2026-Overview of E&M Documentation Guidelines

Pdf Summary

The presentation reviews Evaluation and Management (E&M) coding for 2027, emphasizing the need for physicians and practices to keep pace with documentation, coding, and reimbursement rules. Outpatient and hospital documentation requirements have been simplified; documentation should focus on a medically appropriate history and exam, plus medical decision-making (MDM) or time.

<strong>Billing by MDM:</strong> Select the level using the “best 2 out of 3” elements: problems addressed, data reviewed and analyzed, and management risk. The presentation maps MDM levels to office and inpatient codes, including 99202–99205 for new patients, 99212–99215 for established patients, and 99221–99223 and 99231–99233 for hospital care. A condition is not stable if the patient is not at the treatment goal. Risk examples include prescription drug management, surgery decisions, and hospitalization. Social determinants of health and barriers to care should be documented and may support risk assessment. Prescription management depends on the clinician’s management of the medication; OTC drugs or multiple medications may also contribute to moderate or high risk.

<strong>Billing by time:</strong> Count total time spent on the visit day—not only face-to-face time—including reviewing tests, examining the patient, ordering medications, documenting, and coordinating care. Work completed the night before does not count. The presentation provides time thresholds for office and inpatient codes, with add-on codes 99417 and 99418 for each additional 15 minutes.

The presentation also highlights the relationship between E&M coding, productivity, and reimbursement, and directs clinicians to ASGE and CMS resources for coding guidance.

Asset Subtitle

Edward Sun, MD, MBA, FASGE

Meta Tag

Concept EM Coding

Concept Medical Decision Making

Concept Risk

Concept Time-Based Billing

Concept Documentation

Keywords

E&M coding

2027

medical decision-making

documentation requirements

billing by MDM

billing by time

outpatient coding

hospital coding

reimbursement rules

CMS guidance

EM Coding

Medical Decision Making

Risk

Time-Based Billing

Documentation