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E/M Coding is Changing: Why it’s Important for your Practice to take Note

by | Nov 24, 2020

As the calendar page turns over to another year, a big opportunity for medical practices to reduce administrative burden, bill more accurately, and increase profitability and care quality is on the horizon. In 2021, the Evaluation and Management (E&M) coding system will undergo its most significant E&M changes in decades. Practices who act now to take advantage of these new billing codes will be in a strong position to both increase profits and decrease workflow burdens in 2021. 

“The purpose behind the E&M coding updates is to help keep the physician’s focus more on the patient, and less on documentation and billing,” said Jamie Conklin, an E&M coding expert and Senior Practice Consultant with Medical Advantage. “In 2021, major changes to E&M codes can certainly help practices work more efficiently, but staff has to be aware of these changes to take advantage of updates to E&M coding.” 

Conklin and other Medical Advantage experts were in attendance during the unveiling of the new E&M coding system and offered several takeaways. The good news is that, overall, the new system seems to make new patient billing requirements less cumbersome and doesn’t seem to have much impact on established patient billing. However, under the new E&M coding system, the need for periodic chart audits is more important than ever—this will help ensure a smooth transition during the first significant change to office and outpatient services billing in almost 30 years. 

Lastly, a large change to billing based on time is worth noting. “Recording time during the office visits is going to be a new concept for all providers,” Conklin said. “Under the new E&M coding requirements for 2021, it’s recommended to record time even if you aren’t planning to bill based on visit time. This is because, with the new coding guidelines, time spent with the patient might result in a higher code than using Medical Decision Making (MDM).” 

Of course, the exact changes caused by these updates are far more complex, involving changes to individual codes, definitionscategories and billing options. For example, there has been the introduction of a new E&M code 99417 for prolonged office visits, the elimination of the 99201 code, the introduction of a new requirement to replace the History/Exam requirement, and much more. 

Medical Advantage’s expert team of practice transformation consultants and billing and coding consultants understand both how crucial it is to code and to bill properly in order to maximize productivity and increase profitability and return on investment for medical practices. Our experts also bring in-practice experience and understand how confusing and headache-inducing understanding and implementing new billing and coding requirements can be.  

A comprehensive, up-to-date knowledge of these E&M codes is the best way for physicians to get the most out of their labor. Contact our consultants today to see how we can help your practice stay ahead of E&M coding updates and increase return on investment for your medical practice in 2021. 


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