Learn about key evaluation and management (E/M) code changes coming in 2021 during a daylong Practice Management & Coding Update on Tuesday, Nov. 10, at ACR Convergence 2020. Led by moderators Antanya Chung-Gardiner and Carla Parris, the workshop will include a brief history of E/M codes and why broad changes have been implemented to reform physician payments and reduce the administrative burden associated with these services.
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The bulk of the workshop will focus on key coding policy changes for 2021 and beyond. Sean Weiss, CHC, CPC, partner, vice president and chief compliance officer at DoctorsManagement, Knoxville, Tenn., and Jean Acevedo, CHC, CPC, president and CEO, Acevedo Consulting Inc., Delray Beach, Fla., will discuss the impact of the 2021 coding changes on physician practices. All E/M coding changes apply only to office or other outpatient service codes, including telehealth services, and do not apply to hospital or other E/M codes.
Among the key coding changes is the requirement for providers and physician practices to choose a level of service for office visits with either medical decision making (MDM) or time spent. Under the new codes, the history and exam will no longer be scored, although they still have to be documented and support medical necessity. Instead, physicians need to decide whether to code using the MDM component (including diagnoses, data and complexity, and risk) or the total time spent, including face-to-face and non-face-to-face time with the patient, which can now be reported as a range of time.
“I believe participants will be delighted to hear that only a clinically appropriate history and physical exam will be required from a coding perspective, [with] no more counting bullets or systems,” says Ms. Acevedo, who underscores the need for rheumatologists to understand the three elements of MDM and new definitions, such as “problem addressed” and “stable chronic illness,” that are critical for proper coding. Rheumatologists will find these new documentation requirements very beneficial, she says.
Mr. Weiss will cover traps that providers need to avoid when implementing these new codes. For example, it’s important to understand how to define “medical necessity,” how it is understood legally and how it is used by Medicare. He will describe how providers can establish medical necessity and how to effectively appeal claims.
Mr. Weiss will also talk about the impact of coding changes on compliance and how the June 2020 update will affect enforcement of the U.S. Department of Justice’s guidelines on corporate compliance programs. He will focus on three critical questions that providers and physician practices need to address: 1) how well their corporation’s compliance program is designed; 2) whether the compliance program is being applied earnestly and in good faith; and 3) whether the compliance program works in practice.