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ACP Rolls Out Tools to Help Physicians Use New E/M Codes

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Toolbox of resources provides quick, easy tips and examples to bring physicians up to speed in implementing the new codes

March 5, 2021 (ACP) – Increased payments for office visits and other evaluation and management (E/M) codes under Medicare, along with reduced documentation requirements for using these codes, is one of the biggest advocacy wins for internists in the recent past.

While the codes are much simpler to use, there is a learning curve, and the American College of Physicians is rolling out new resources and tools to help internists get up to speed on the changes, said Brian Outland, ACP director of regulatory affairs. The new toolbox includes an E&M coding implementation check list, a summary of 2021 E/M changes and details on how to use the new codes. ACP is also working on a voiceover PowerPoint presentation, Outland said. “This will provide quick, easy tips and documentation examples, so physicians can learn without having to sit for hours in a seminar,” he said.

The U.S. Centers for Medicare & Medicaid Services increased relative value unit payments for E/M codes effective Jan. 1, 2021. This change will result in an estimated 6 percent increase in total 2021 Medicare payments to internal medicine physicians. In addition to increased payments, CMS reduced the burden for documenting these codes.

Physicians who are billing for Medicare no longer have to use a patient's history or physical exam to determine the appropriate level of E/M coding, Outland explained. This results in significantly less reporting burden for physicians.

While physicians are still required to perform a physical exam and determine a patient's medical history, they will no longer have to use two of the three elements (history, exam and medical decision-making) to determine the level of E/M coding to bill, Outland explained. “A physician can now, rather than going through several key components, use time or medical decision-making to select a code,” he said. “Before, you had to document medical history, past family history and a complete exam for the patient; now, all you have to do is document how much time you spent discussing the patient issues or use medical decision-making.”

The new ACP resources will help physicians understand what they can and cannot count as time, Outland said. For example, obtaining and/or reviewing a separately obtained history, performing a medically appropriate examination, counseling and educating the patient, ordering medications, tests or procedures, and referring and communicating with other health care professionals – among other aspects of the visit – can all count as time when billing, he said. Time now includes total face-to-face and non-face-to-face time spent on the day of the patient visit by the physician and/or other health care professionals.

The new tools also help break down the use of medical decision-making codes, which consider the number and complexity of problems addressed during the visit, the amount and/or complexity of data reviewed and analyzed during the appointment, and the risk for complications, morbidity and/or mortality of patient management decisions associated with the patient's problems, the diagnostic procedures and treatments at the visit. These elements help to determine the level of medical decision-making – whether straightforward, low, moderate or high, Outland explained.

More Information

The new resources are available in the Practice Resources section of the ACP website.

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Back to the March 5, 2021 issue of ACP Advocate