Pre-Conference Workshop - Another Day, Another Dollar: How to Improve your Billing and Coding-EM Coding Time vs. Intensity

EM Coding Time vs. Intensity

Pdf Summary

The document, authored by Dr. Sarah Collins, provides a comprehensive overview of Evaluation and Management (E/M) coding, emphasizing changes post-2021, focusing on time-based billing and Medical Decision Making (MDM). Dr. Collins, a consultant for MCG Health, sets learning objectives which include understanding the criteria for outpatient visit complexity and appropriate office E/M billing. <br /><br />Prior to 2021, key aspects for determining E/M levels focused on history, physical exams, and medical decision making. History was categorized into HPI, ROS, and PFSH, determining levels from problem-focused to comprehensive. Physical exam documentation also followed a similarly tiered approach.<br /><br />Significant changes in 2021 included the removal of CPT 99201 and the alteration of time criteria from CPT 99211. E/M service levels (CPT 99202-99215) are now primarily determined by MDM or time spent, abandoning historical use of history and exams. New prolonged codes (CPT 99417/G2212) were introduced for services exceeding standard time limits.<br /><br />MDM now involves three key elements: number and complexity of problems, amount and complexity of data reviewed, and risk of complications or morbidity. These elements aid in determining service levels, categorized as minimal, low, moderate, or high complexity/risk.<br /><br />The document illustrates practical examples of E/M coding using patient scenarios, explaining the balance between time-based billing and MDM. These examples reflect how time spent and intensity of medical decision-making impact service level billing.<br /><br />It also outlines that time-based billing now includes all professional activities on the encounter day, excluding staff time. This allows for a better reflection of the provider's work, ensuring alignment with the extensive requirements of patient care documentation and management in determining overall service levels.

Keywords

E/M coding

time-based billing

Medical Decision Making

CPT 99201 removal

CPT 99211 alteration

prolonged codes

MDM elements

service level billing

patient care documentation

outpatient visit complexity