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Insight into 2021 E/M Coding Changes

2021 E/M coding changes

There have been some considerable changes made to the Medicare outpatient evaluation and management (E/M) codes, and physicians across all specialties are likely to experience the impact.

Some of the professionals who should acquaint themselves with the recent E/M coding changes include coders, physicians, health information managers, and those who manage patient information.

The idea behind the 2021 E/M coding changes includes:

• Ensuring payment for E/M is resource-based while eliminating the immediate goal for redistributing costs between specialties.
• Decreasing the administrative burden of coding and documentation.
• Reducing unnecessary documentation during the provision of healthcare services.
• Reducing the need for frequent audits.

Below, we’ve listed a few details outlining what to expect.

Going forward, E/M documentation will prioritize medical decision making (MDM) or time. The implication is that the capture of history and exam elements will only happen if the available information is clinically appropriate.


The categorization of MDM elements is as follows:
The risk of complications and/or morbidity or mortality of patient management : Any decision involving a patient’s problem(s) or treatment(s) in this case will include possible management options and the risks that come with social determinants of health.

Number and complexity of problems : A physician or any other qualified professional evaluates a problem and addresses the same after that.

The amount and/or complexity of the data that needs analysis or review : This is the most significant change that focuses on clinically essential activities.

Additionally, the change accounts for the number of documents one orders or reviews. On the other hand, the division of data comes in three categories, including:

• Discussions regarding the management of test interpretation with an external physician/an appropriate source/other QHP.
• Orders, tests, documents, or independent historian(s).
• Independent interpretation of tests.


Time criteria
The aspect of tracking time may be unpopular in urgent care settings, but insight into how one can use time when medical coding visits is critical. The “reporting” practitioner considers both face-to-face and non-face-to-face engagements on the encounter’s date under the new regulations.

When documenting time, the CMS updates require professionals to state the total time they spend interacting with patients and summarize the services they perform.

Activities that may count toward time-related E/M codes include:
• 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.

The simplification of documentation requirements and administrative responsibilities by introducing the 2021 E/M coding changes reduces managerial concerns. The goal is for physicians to be able to spend more quality time with their patients.



For more on Medical Billing & Coding, Healthcare Administration, and Insurance News and Updates, you’re already at the right place. Be sure to stay on top of everything by subscribing to the Rx for Success Medical Billing Blog here!

Also, check out our article on how to E/M Codes: Translating Quality into Payment , Why the-25 Modifier is so important to Medical Coding and our How to Bill for a Non-Credentialed, Temporary, or Substitute Hire

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