HCPro, JustCoding Outpatient - 2020 Issue 38 (October)
With E/M code 99201 on the chopping block, prepare for shifting MDM elements
October 6th, 2020
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Article Overview
This article reviews upcoming changes to outpatient evaluation and management coding for office visits, including the deletion of one new patient code, revisions to the remaining office E/M descriptors, and the shift toward medical decision-making or time in level selection. It is aimed at coders, auditors, and physician practice staff who need to understand how the changes affect documentation review, retrospective analysis, and code selection for office visit services.
Why This Topic Matters
It helps practices prepare for major E/M office visit revisions, evaluate how documentation expectations are changing, and align auditing and reporting processes across the transition year.
Article Sections
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Overview of the upcoming E/M changes
Introduces the planned office visit revisions and the overall areas affected. Summarizes the shift in focus for outpatient E/M reporting.
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Mainly a matter of MDM
Discusses the transition to medical decision-making as a central element in office visit level selection. Covers the broad categories of documentation and complexity involved.
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The time alternative
Reviews the option to select office visit levels based on time. Describes the types of provider activities that may be counted under the revised approach.
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New elements to watch for
Highlights additional documentation considerations that may affect office visit leveling under the revised framework. Notes a new risk-related category discussed in the article.
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How to audit 99201 services
Explains retrospective auditing considerations for practices comparing office visit volume across the transition. Addresses how to think about pre-change and post-change utilization review.
What You Will Learn
- How the upcoming office E/M changes affect outpatient visit reporting
- Why documentation quality becomes more important under the revised framework
- How time-based reporting differs from prior office visit time concepts
- What auditors may consider when comparing office visit utilization across years
- Which broad documentation themes may influence higher-level outpatient E/M selection
Who Should Read This
- Medical coders
- Coding auditors
- Physician practice managers
- Clinical documentation integrity professionals
- Physicians and advanced practice providers
Codes Discussed
Code Ranges Discussed
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