Neurology & Pain Management Coding Alert

Remember that the changes are retroactive to January 1.

When the AMA released the new rules for coding office/outpatient evaluation and management (E/M) services for 2021, everyone knew the rules were a work in progress. With a recent press release and clarification, the AMA has shown that it is still very much involved in finding out what’s working, and what isn’t, and making necessary adjustments.

“The American Medical Association (AMA) and the CPT^® Editorial Panel have heard feedback from the health care community and acted quickly to create revisions to the E/M office visit guidelines that clarify their original intention and reduce confusion,” according to a recent AMA release.

Read on the check out what’s going on with office/outpatient E/Ms.

AMA Acted to Tighten up Rules

In February, the CPT^® Editorial Panel “approved major revisions to the other sections of E/M services that were not addressed in the first round of review (i.e., inpatient and observation, consultations, emergency department, nursing facility, rest home, and prolonged services). It then went on to approve immediate revisions (i.e., technical corrections) to existing guidelines that provide relief to the most confusing areas of current E/M Office Visit reporting,” according to the release.

Impact: Don’t worry about the revisions to E/M codes that weren’t impacted in 2021 — inpatient, observation, emergency department, etc. Those revisions will not be effective until Jan. 1, 2023. However, the technical corrections to the office/outpatient E/M codes “were uploaded to the [AMA] website on March 9, 2021 and go into effect retroactively from January 1, 2021,” according to the release.

MDM Gets Technical Clarifications

According to the AMA, medical decision making (MDM) got the biggest dose of technical corrections. The changes include:

• “Clarifying when reporting a test that is considered, but not selected after shared decision making.
• “Providing a definition of “Analyzed” for reporting tests in the data column.
• “Clarifying the definition of a “unique” test.
• “Clarifying what is meant by “discussion” between physicians, and other qualified health care professionals and patients.
• “Providing a definition of major vs. minor surgery.”

“There will also be clarification around which activities are not counted when reporting time as a key criterion for code level selection,” the AMA reported.