2021 E/M Coding Changes – iSalus Healthcare’s Plan

On January 1st, 2021, the new rules related to billing for Office Visits, set forth by the Centers for Medicare & Medicaid Services (CMS) for evaluation and management (E/M) services, will drastically change.  These new rules are intended to simplify and streamline coding and documentation for E/M office visits, making them clinically relevant and reducing excessive administrative burden.

Major Changes to E/M Coding

Key elements of the E/M office visit overhaul include:

  • Eliminating history and physical exam as elements for code selection. While significant to both visit time and Medical Decision-Making, these elements alone should not determine a visit’s code level.
  • Allowing physicians to choose whether their documentation is based on Medical Decision-Making or total time. This builds on the movement to better recognize the work involved in non face-to-face services like Care Coordination.
  • Changing Medical Decision-Making criteria to move away from simply adding up tasks to instead focusing on tasks that affect the management of a patient’s condition.

Changes to OfficeEMR

To support these changes, iSalus Healthcare will be modifying the E/M Coding module in OfficeEMR.

Current Changes
The current E/M Coding rules require 3 elements – History, Exam and Medical Decision-Making. The new E/M Coding rules only require Medical Decision-Making.  The History and Exam portions will be removed.
The current E/M Coding engine integrates with templates such as History of Present Illness (HPI), Review of Systems (ROS) and Exams to help determine coding level. The new E/M Coding rules do not take into account HPI, ROS or Exam data points.  Therefore, no integration with templates will exist.
The current E/M Coding engine provides guidance on the Medical Decision-Making portion of the rules. Users are required to select the various levels of complexity that exist for the desired patient to obtain a recommendation. The Medical Decision-Making portion of the E/M Coding rules engine will be updated with the new guidance provided by CMS.
The current E/M Coding engine allows for time-based billing using the legacy standards and timing guidance. The E/M Coding engine will be updated to use the new timing requirements for 2021.  Users can choose to bill based on Medical Decision-Making or time when selecting the visit level.

Dig Deeper

In addition to the above changes being made by iSalus, we strongly encourage all practices to dig deeper into these new regulations in order to prepare for this major change.

Learn more about the 2021 Fee Schedule Updates

The 2021 fee schedule is changing for more than just office visits. Several other changes worth reading can be found on the CMS Final Rule Overview here.

Procedure Code Updates

The American Medical Association (AMA) will update and remove some procedure codes in addition to the language around what these codes mean.  Practices using OfficeEMR are responsible for maintaining their own procedure codes and fee schedules.  We suggest you review the procedure codes that you currently have set up in OfficeEMR and update as you see fit.  Procedure codes can be reviewed and changed by navigating to Setup > Procedure Codes.

Superbill Template Updates

Once you have updated your procedure codes, it may also be helpful to modify the Superbill Templates used in the EMR by the medical team.  Superbills can be reviewed and changed by navigating to Setup > Superbill Templates.

EMR Template Updates

After reviewing the new billing rules, you may decide to have templates in your system modified to take advantage of the streamlined documentation requirements.  Template Change Requests can be made by contacting [email protected].