decisionhealth Newsletters, Part B News - 2020 Issue 9 (September)
With 99201 on the chopping block, prepare for shifting MDM elements, audit concerns
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Article Overview
This article reviews upcoming evaluation and management office visit changes tied to the 2021 transition to new AMA and CMS guidance. It is aimed at coders, auditors, and physician practices that need to understand how the revised approach affects documentation, time-based reporting, retrospective comparisons, and audit analysis for office visits.
Why This Topic Matters
The changes affect how office visit levels are assessed, how documentation supports those levels, and how historical utilization is compared across reporting periods. Practices need to adapt their workflows and audit methods to avoid classification errors and misleading trend analyses.
Article Sections
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2021 E/M changes
Introduces the upcoming office visit changes and the general shift in how levels are determined under the revised guidance. Also frames the impact on coding workflows and documentation review.
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Mainly a matter of MDM
Discusses the new emphasis on medical decision-making for office visit level selection and how that affects evaluation of routine new-patient encounters. Covers the broader documentation focus and related considerations for comparing levels.
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The time alternative
Summarizes the option to select office visit levels by time and describes the types of activities that may be included under the revised framework. Also notes the relevant time window discussed for qualification.
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New elements to watch for
Highlights additional documentation elements that can affect risk assessment under the updated guidance. Focuses on issues that may influence level selection in certain cases.
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How to audit 99201 services
Explains retrospective audit and comparison considerations for office visit utilization across the transition period. Addresses how historical and post-change samples may be analyzed for trend review.
What You Will Learn
- How the 2021 office visit changes affect evaluation and management coding
- What documentation themes become more important under the revised selection approach
- How time-based office visit reporting is discussed in the article
- What audit and comparison issues arise when reviewing historical office visit utilization
- Which organizations and experts are referenced in connection with the transition
Who Should Read This
- Medical coders
- Coding auditors
- Physician practice managers
- Clinical documentation integrity professionals
- Primary care and outpatient billing staff
Codes Discussed
Code Ranges Discussed
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