ED Coding & Reimbursement Alert - 2020 Issue 8
Countdown to 2021: Code This Case Study, Keep Next Year's Office and Outpatient E/Ms On the Level
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Article Overview
This article compares an established-patient office and outpatient E/M case study under 2020 and proposed 2021 guidance. It is aimed at coders, billers, and practice staff who need to understand how changes to E/M leveling may affect documentation review, code selection, and revenue planning. The discussion focuses on general history, exam, MDM, and time-based considerations, along with the uncertainty created by pending CPT and CMS updates.
Why This Topic Matters
It helps readers gauge whether their current E/M coding processes may produce different results under the revised office and outpatient framework, which can affect compliance and financial forecasting.
Article Sections
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The Note
Presents the patient scenario, relevant symptoms, exam findings, diagnosis, and treatment context used for the comparison.
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E/M Level Per 2020 Guidelines
Reviews how the case is evaluated under the existing office and outpatient E/M framework, including the major documentation elements considered.
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Levelling Under 2020 Time Guidelines
Explains the role of time under the current rules and how it relates to the encounter’s overall level.
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What Happens to the Same Scenario on Jan. 1, 2021?
Compares how the same case is approached under the updated office and outpatient E/M framework and discusses the broader implications of the change.
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The Bottom Line
Summarizes the expected operational impact of the revised guidance and the need for monitoring and audit planning.
What You Will Learn
- How an established-patient office visit may be assessed under current and proposed E/M guidance
- Which documentation elements are considered in office and outpatient E/M leveling
- How time-based and MDM-based selection are discussed in the context of the case study
- Why pending CPT and CMS actions matter for final coding and payment outcomes
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Practice managers
- Physician and clinic documentation teams
Codes Discussed
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