Wiki 2021 new guidelines may affect reimbursement?

[wynonna]

In an initial review of ENT notes, I'm finding lower levels this year than last year for 99213 established patient E&M CPT codes.
Factoring in presenting problems from first column, If 1 or less tests are reviewed, I see level 2 overall score. If no OTC is recommended, and no RX is given, again I see level 2 overall score.
Are others finding this is the case, that what formerly was a level 3 which included the (first box in MDM--(number of diagnosis and management options) is now a 99202/99212?
Without this first box, which is now absent, we are looking at the number of tests in the 2nd column or OTC/Rx to gain a level 3 or higher.
I understand in first column from Table of Risk, that we can count presenting problems. But we still need 2 or more tests ordered/evaluated OR independent historian OR OTC to score a 99213.
Am I correct?
Are any of my fellow coders noting this as a major change from last year to this year?
thank you

 

[thomas7331]

I'm not quite following what you're saying here about the first box and the first column. The three categories of MDM - number of problems, data and risk - are still the same, and you still just need two of the three of these to meet the level you're assigning. The only thing that changing is the criteria within each of these three categories. And in the risk category, as before, you only need one item to meet the level of risk - you don't have to meet the presenting problem and the risk of complication both in order to qualify your level of risk.

So even if the data doesn't meet level 3 as you're describing here, you can still meet the level by having one stable chronic condition - that meets the requirements for Low MDM by meeting the level in both the number of problems category and the risk category. Does that make sense or am I still misunderstanding your question?

 

[wynonna]

Yes, thank you, that does make sense. So 1 stable chronic illness always corresponds to low level Risk of complications and/or morbidity? (rather than minimal/ self-limited or minor) Is there a source or specific guideline that tells us this?