With healthcare news coverage currently dominated by pundits analyzing President Joe Biden’s policy and experts explaining vaccine logistics, the new evaluation and management (E/M) coding changes haven’t received much media attention. However, the revised Current Procedural Terminology (CPT®) codes for office and outpatient E/M, which went into effect January 1, are an incredible step for the industry.
In many ways, coding best encapsulates healthcare’s evolution. These updates and changes by the American Medical Association (AMA) capture many of the industry’s advances. For example, several new codes are designed to capture technological innovation and telehealth’s greater use and flexibility in response to the COVID-19 pandemic.
Beyond technological advances, healthcare has shifted immensely since the codes’ last major overhaul more than 25 years ago. As I’ve written before, E/M coding plays a vital role in properly treating patients. The updates reflect our changing understanding of patient care and the patient-physician relationship. This prioritization is seen in the changes to coding by time.
How Does Coding by Time Work Now?
Before 2021, coding by time was only allowed if more than half of the visit was dedicated to counseling or care coordination. Now, physicians can count the total time before, during, and after the patient visit regardless of what portion is focused on care coordination or counseling, as long as the time occurs on the same date of service as the visit.
According to the AMA, time-related E/M codes now cover:
- Reviewing tests in preparation for a patient’s visit.
- Counseling or educating a patient, family or caregiver.
- Reporting test results to a patient by phone.
- Ordering medications, tests or procedures.
- “Pajama time” documentation work performed at home.
This change recognizes the significant amount of time physicians spend caring for patients outside the actual appointment. Coding by time may also become more prominent as providers address mental health issues resulting from the COVID-19 pandemic. Providers can also use coding by time to account for time spent addressing patients’ concerns or misconceptions about vaccine safety.
How Can the Changes Increase Revenue, Combat Burnout, and Enhance the Patient Relationship?
Many practices are feeling the economic strain caused by COVID. More than half of primary care physicians are uncertain about their financial future and viability. Improved coding can help stabilize revenue and ensure proper reimbursement. As Carleigh Moore, Revenue Optimization Manager at Privia Health, noted: “Revenue integrity can help practices navigate the unpredictable future with more confidence.”
Additionally, the coding changes recognize and reimburse the work providers do outside a patient’s appointment. A study published in the Annals of Family Medicine found that physicians spent more than half of their working hours using their electronic health record (EHR). About one-third of this time was dedicated to medical care, such as chart reviews. Reimbursing providers for this valuable and necessary time can help curb physician burnout, which has increased greatly during the pandemic.
Finally, the changes to coding by time can strengthen the doctor-patient relationship. The new guidelines encourage counseling, patient or caregiver education, care coordination, and more to foster robust, holistic patient care and engagement.
How to Best Use the New Codes
Because there is an adjustment period for any major change, it is important for providers to understand how the new codes work as soon as possible. A key point is learning when to code by time versus medical decision-making (MDM). If the doctor spent considerable time pre-visit reviewing the patient’s history, it may be better to bill for time. On the other hand, if the physician ordered several tests or consulted with specialists, coding by MDM may be preferable.
While adapting to the new E/M codes, it is crucial that providers focus on thorough, complete documentation. The American Academy of Professional Coders™ suggests providers ask themselves the following questions while documenting:
- Does my progress note contain a medically appropriate history and examination?
- Did I address the diagnoses appropriately?
- Did I document all orders and data reviewed?
- Did I work with other professionals?
- Did I use an independent historian?
- Does the documentation support the level of risk I chose?
Although the change may be difficult, these coding revisions are an exciting move for healthcare. To help with the transition, visit the AMA’s “Implementing CPT® Evaluation and Management (E/M) Revisions” page for videos, webinars, and other resources. As Andis Robezieks noted for the AMA, “Changes to the code descriptors and guidelines for evaluation and management (E/M) services delivered during office visits and other outpatient encounters provide an opportunity to rethink outpatient documentation while reducing physician burnout.”