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AMA Releases Important Updates

AMA Releases Important Updates March 16, 2021

The AMA released their CPT Errata and Technical Corrections document on March 9th . The document largely includes clarifications and updates to the Evaluation and Management (E/M) Introduction Guidelines for office/outpatient services (99202-99215) that went into effect on January 1, 2021.  The updates are in response to issues and questions related to the new guidelines.  

The CPT E/M Technical updates for E/M Guidelines include:

  • Clarification on what time spent on an encounter does NOT include
    • The performance of other services that are reported separately
    • Travel
    • Teaching that is general and not limited to discussion that is required for the management of a specific patient
  • Clarification on which types of tests do or do not count towards MDM
    • Tests that do not required separate interpretation (eg, tests that are results only) and are analyzed as part of MDM do NOT count as an independent interpretation but may be counted as ordered or reviewed for selecting an MDM level
  • Additional sections within “Guidelines Common to All E/M Services Reported Separately” to include definitions of “Analyzed”, “Unique”, “Combination of Data Elements”, and “Discussion”
  • Additional section defining Surgery categories
    • Minor or Major
    • Elective or Emergency
    • Risk Factors, Patient or Procedure
  • Additional clarifications for overall medical decision making (MDM)
    • Ordering a test may include those considered, but not selected after shared decision making.  For example, a test may be normally performed, but due to the risk for a specific patient it is not ordered.  The considerations must be documented.

All updates should be shared with providers and coders within your organization to facilitate appropriate documentation and coding. 

The AMA revised guidelines are located at: https://www.ama-assn.org/system/files/2020-12/cpt-corrections-errata-2021.pdf

HBE’s team of coding and compliance experts is available to assist you external reviews of your documentation, coding and reimbursement as well as providing customized education and training for your staff.  We are also available to provide assistance with conducting risk assessments, internal investigations and policy and procedure development.  

DISCLAIMER:  This newsletter contains only summary information and highlights; it should be read in conjunction with the full article or document provided as a link.  Any advice or recommendations are general and specific questions should be directed to professional counsel.

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