EM Coding Alert
Will You Choose Time or MDM for Your 2021 E/Ms? Here’s How to Decide.
Making the wrong choice could cost your practice dearly. By now, it should be common knowledge: beginning on January 1 next year, when you report an office/ outpatient E/M service you’ll use either time or medical decision making (MDM) as the determining factor for the service level. But even though the change should make your life easier, making the wrong choice could make it much harder. Because choosing incorrectly could cost your practice some serious money in lost reimbursement. So, to make those decisions less complicated, we asked a leading E/M coding expert to design a case study that will help you understand how to make the right choice quickly, easily, and correctly. The Case Here’s the scenario, courtesy of with Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington: A 75-year-old established patient presents for follow-up of a previous T-10 spine fracture related to her osteoporosis. She has multiple comorbid conditions, including type 2 diabetes mellitus (DM) controlled with insulin; mild chronic obstructive pulmonary disease (COPD); bradycardia; arthritis; and a history of a poor reaction to anesthesia. For these reasons, she is not a candidate for surgical repair of her fracture. The provider reviews her X-rays, her recent lab results, bone scan results, and the most recent note from her primary care physician (PCP), who is managing her multiple problems and coordinating with her various care providers. Her fracture is improving but requires careful management. Your practice sends her PCP a letter updating her status along with a copy of your provider’s clinical note. The visit takes about 15 minutes. E/M Coding by Time The entire encounter took 15 minutes, so if you report this service based on time in in 2021, you’d report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter). E/M Coding by MDM If you report this same encounter based on MDM in 2021, you’d report 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter. …). According to Bucknam, the provider treated multiple established conditions; reviewed test results (both radiology and lab); and coordinated with the patient’s PCP. In 2021, this puts MDM at high for this encounter despite its brevity. The decision: Clearly, you should use MDM to report this encounter in 2021. Be sure, however, that you don’t automatically use MDM every time you choose an E/M code in 2021. There will be instances where time will be the better measuring stick when choosing your office/ outpatient E/M code. ICD-10 Coding Remember: As you focus more intently on the E/M levels for 2021, don’t sleep on diagnosis coding. If you get the wrong ICD-10 codes, patient care and reimbursement could be negatively affected. Here’s a breakdown of the ICD-10 codes you should append to the 99215, according to Bucknam:
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