decisionhealth Newsletters, Coder Pink Sheets - 2020 Issue 7 (July)
Decision time: Navigate revisions to levels of MDM amid coming E/M changes
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Article Overview
This article is a practical overview for medical practice leaders, coders, and documentation staff preparing for office and outpatient E/M changes in the CPT system. It discusses the scope of the revisions, the shift in documentation emphasis, the updated medical decision-making framework, and implementation planning considerations for 2021. The article is relevant for practices that bill E/M services and need to prepare templates, training, and financial analysis around the revised guidance.
Why This Topic Matters
The changes described affect one of the most commonly reported E/M code families and require advance preparation to avoid documentation, workflow, and claims issues when the revised rules take effect.
Article Sections
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Why the E/M changes are happening
Introduces the broader shift in office and outpatient E/M coding and explains the context for the upcoming revisions. Summarizes the organizations and guideline sources involved at a high level.
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Glimpsing the 2021 outlook
Describes the major structural changes planned for the office and outpatient E/M code set. Covers the general direction of the revised documentation approach and the intended impact on code selection.
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Calculating MDM: A new frontier
Reviews the updated medical decision-making framework and its main components. Highlights how the revised structure organizes the factors used in selecting service levels.
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Take steps to implement the change
Discusses preparation activities for practices as they transition to the new rules. Focuses on planning, documentation review, training, workflow updates, and financial analysis.
What You Will Learn
- The overall scope of the coming office and outpatient E/M revisions
- How the revised documentation approach changes the role of history and exam in code selection
- What the updated medical decision-making framework is intended to address
- How practices can prepare operationally for the transition to the new E/M guidance
Who Should Read This
- Medical coders
- Coding managers
- Physicians
- Practice administrators
- Compliance staff
- Revenue cycle teams
Codes Discussed
Code Ranges Discussed
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