2021 E/M Coding Change: Making Sense of Unexpected Findings
Authors: Christine A. Sinsky
Journal: Annals of Internal Medicine (2022)

EditorialsApril 20222021 E/M Coding Change: Making Sense of Unexpected FindingsChristine A. Sinsky, MDChristine A. Sinsky, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-0355 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The evaluation and management (E/M) coding guidelines needed to be fixed. On 1 January 2021, the Centers for Medicare & Medicaid Services (CMS) implemented changes recommended by the Current Procedural Terminology Editorial Panel intended to reduce administrative burden and unnecessary documentation (1). These changes are among the most consequential payment changes of the past 3 decades. Now, when billing by content, the level of service is determined only by medical decision making; history and examination are not scored. When billing by time, all physician time on the day of service, including before and after the visit, is now included, with ...References1. American Medical Association. CPT Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99417) Code and Guidelilne Changes. 2021. Accessed at www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf on 17 January 2022. Google Scholar2. Centers for Medicare & Medicaid Services. 1997 Documentation Guidelines for Evaluation and Management Services. Accessed at www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnedwebguide/downloads/97docguidelines.pdf on 12 January 2022. Google Scholar3. Kissler MJ, Kissler K, Burden M. Toward a medical “ecology of attention”. N Engl J Med. 2021;384:299-301. [PMID: 33503689] doi:10.1056/NEJMp2027190 CrossrefMedlineGoogle Scholar4. Apathy NC, Hare AJ, Fendrich S, et al. Early changes in billing and notes after evaluation and management guideline change. Ann Intern Med. 2022;175:499-504. doi:10.7326/M21-4402 LinkGoogle Scholar5. American Medical Association. Debunking regulatory myths. 2019. Accessed at www.ama-assn.org/amaone/debunking-regulatory-myths on 17 January 2022. Google Scholar6. Sinsky CA, Bodenheimer T. Powering-up primary care teams: advanced team care with in-room support. Ann Fam Med. 2019;17:367-371. [PMID: 31285215] doi:10.1370/afm.2422 CrossrefMedlineGoogle Scholar7. Germack HD, Leung L, Zhao X, et al. Association of team-based care and continuity of care with hospitalizations for veterans with comorbid mental and physical health conditions. J Gen Intern Med. 2022;37:40-48. [PMID: 34027614] doi:10.1007/s11606-021-06884-5 CrossrefMedlineGoogle Scholar8. Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med. 2016;165:753-760. [PMID: 27595430] doi:10.7326/M16-0961 LinkGoogle Scholar9. Catanese SJ. Understanding the complexities of overhead in a physician practice. Western Pennsylvannia Healthcare News. 7 August 2013. Accessed at www.wphealthcarenews.com/understanding-the-complexities-of-overhead-in-a-physician-practice on 17 January 2022. Google Scholar Author, Article, and Disclosure InformationAffiliations: Disclaimer: Dr. Sinsky is employed by the American Medical Association. The opinions expressed in this article are those of the author and should not be interpreted as American Medical Association policy.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-0355.Corresponding Author: Christine A. Sinsky, MD, American Medical Association, 330 North Wabash Avenue, Suite 39300, Chicago, IL 60611; e-mail, christine.[email protected]org.This article was published at Annals.org on 22 February 2022. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEarly Changes in Billing and Notes After Evaluation and Management Guideline Change Nate C. Apathy , Allison J. Hare , Sarah Fendrich , and Dori A. Cross Annals On Call - Making Sense of E/M Coding Changes Robert M. Centor , Nate C. Apathy , and Ryan D. Mire Metrics April 2022Volume 175, Issue 4Page: 602-603KeywordsElectronic medical recordsMedicaidMedicareOutpatients ePublished: 22 February 2022 Issue Published: April 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...