Effective January 1, 2021 CMS is aligning E&M coding with changes adopted by the American Medical Association’s CPT Editorial Panel for office/outpatient E&M visits. Providers will want to align clinical documentation and coding with the new E&M standards, which:
- Retain 5 levels of coding for established patients
- Reduce the number of levels to 4 for office/outpatient E/M visits for new patients, and revises the code definitions
- Revise the times and medical decision-making process for all the codes, and requires performance of history and exam only as medically appropriate
- Allow clinicians to choose the E/M visit level based on either medical decision making or time
What do NextGen Healthcare Clients Need to Do?
Clinicians and coding staff should familiarize themselves with the new guidelines, as there will be likely impacts on visit documentation and workflow, in addition to required updates to their NextGen Healthcare software.
- NextGen® Enterprise – NextGen® Adaptive Content Engine templates have been updated to support the new guidelines. These updates are available today as part of NextGen Enterprise version 5.9.2020.1 or by installing the latest cumulative patches. To be receive the patches, visit the Most Recent Product Releases and Patches page on Success Community and download the current cumulative patch for NextGen® Enterprise and NextGen® Adaptive Content Engine.
- NextGen® Office – The NextGen® Office platform has been updated to support the guidelines. To incorporate these updates into your workflow, access new content from E&M 2021 Tab in Procedure Coding.
For more information…
- Review the CY 2020 Physician Fee Schedule Fact Sheet and the Medicare Learning Network®(MLN) Connects Physician Fee Schedule and OPPS/ASC Final Rules Call (transcript, recording and presentation posted here).
- Contact the American Medical Association and your specialty academy for general information and clinical workflow implications.