As we close the first week of the new E/M coding guidelines – assuming your brain spasms are resolving – you might be wondering how the changes line up to payments. Are you better or worse off under the new coding requirements? According to this article, you’re better, so hang in there! The author uses the case of a single worsening chronic problem, which would have required low-level decision-making, or Level 3, in 2020.
Under the 2021 coding guidelines, it moves to moderate decision-making or Level 4 because “all your worsening, exacerbated, poorly controlled, uncontrolled, inadequate response to treatment and the new label ‘not at goal,’ will most often result in an adjustment to medications either in dosage or a change in regimen.” So while in 2020, a Level 4 visit would require one stable and one worse assessed condition, 2021 requires only one with a medication change.
In addition, a ‘severe worsening or exacerbated’ problem that involves ‘a decision regarding hospitalization’ – which would have been a Level 4 visit in 2020 – now qualifies for Level 5. As the author concludes, the MDM tables in 2021 seem to result in higher visit levels and associated payments without doing anything differently, a win-win!
To read more about the specific changes in E/M coding for 2021, click here.