E/M Coding: Heed These 7 Factors That Impact New E/M Rules

Why This Topic Matters

The 2021 E/M revisions changed how many common office and outpatient visits are selected and documented, so accurate understanding matters for compliant reporting and appropriate claim submission. The article is especially useful for those working with Medicare and other payers that adopted or aligned with the updated framework.

Article Sections

1. Physicians Led the Charge to Change the E/M Guidelines

   Introduces the background behind the updated office and outpatient E/M framework and the policy goals associated with the 2021 changes. Also provides historical context from prior CMS updates.

2. Learn How Chief Complaint Documentation Rules Have Shifted

   Summarizes how chief complaint documentation expectations changed under the revised E/M approach. Focuses on documentation workflow and review concepts.

3. You Can Include Non-Face-to-Face Time When Tallying Code Levels

   Explains the article’s time-based reporting discussion for office and outpatient E/M services. Covers general considerations for documenting and tallying time under the revised framework.

4. Don’t Double-Dip When Tallying Time

   Addresses how time is handled when E/M services occur alongside other separately reportable services. Includes discussion of shared encounter time and related documentation concerns.

5. Realize 99211 Remains, But 99201 Is Gone

   Notes changes affecting specific established-visit and deleted visit categories within the office/outpatient E/M code set. Provides a brief status update on these codes.

6. Note The Table Looks Different

   Reviews the revised medical decision-making structure used for selecting office and outpatient E/M levels. Covers the broad organization of the updated table and its data, risk, and problem-focused elements.

7. Apply New Prolonged Services Code to Medicare Claims

   Discusses the Medicare-specific prolonged services update tied to office and outpatient E/M reporting. Also mentions related prolonged service categories that remain relevant to other service types.