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[Music] hi everybody its Angela coder and today we're gonna start diving into the 2021 e/m changes you guys unless you've been under a rock out there somewhere you probably are aware that in 2021 the evaluation and management codes are going to change the AMA has posted that information out there and I'm going to put an actual link to the guide that I'm going to be discussing today in the description below that way you guys can actually go and get the source document that I'm gonna be talking about today but what we're gonna talk about today are five facts that you need to know before the e/m changes in 2021 so let's get started okay as promised today we are gonna talk about five facts you need to know about the twenty twenty-one IAM changes and without further ado let's hop on in that number one not all AM codes are going to change these changes are not gonna affect every single e m' code only certain ones and I've heard all kind of riff rumors and myths about how iam coding is going away and we won't need to be doing auditing at all anymore and all kind of different myths but hopefully this video is going to dispel some of those myths because although a lot is changing it's not everything not everything is changing so let's see what is changing first of all office codes 99202 through nine nine two one five will change in I did write that correctly 99201 is going away it will not be in the twenty twenty one code book and I'm gonna show you why in just a moment so also changing will be the prolonged services codes nine nine three five four five five five six and I think also five seven which I don't have on the slide right here and there will be the addition of prolonged service code 9 9 X X X yes X's but I typed that correctly we're gonna have CPT code that a CPT code for an e/m that has X's on it interesting huh so this is something very new and not like anything we're used to before so let's go on to what about fact number two all right for fact number two this is the one that's probably gotten the most buzz out there and that's that the history and exam is going to change so history and exam will no longer be used to level office visits and it's just office visits this has nothing to do with any of the other em2 they will still be done the same but for the office visits codes 99202 through none unto 1:5 we will no longer be counting bullets for the exam we will no longer be figuring the level of of HP I review assistants past medical family all of that is going away in 2021 for the CPT codes 99202 through 9 and 2 1 5 there will still need to be a medically appropriate history and exam documented so the documentation of a history and exam do not go away that is still necessary for good patient care and it is still expected to be in the record but we will not be using that information to level those services this will not change for any of the other am codes I'm just reiterating that again this is only for the office visit codes 99202 through none on two one five fact number three now we can level EMS using only medical decision making now since since they've taken away and said we don't have to level based on history and exam anymore we do have two things we can level on we can either level based on the met decision-making or we can level based on time so the first one we're going to look at is how to level with MDM all right there will be four levels of MDM you will have let me look get them real quick and make sure I give them to you you're gonna still have straightforward low moderate and high just like you did before but the levels are gonna line up with the numbers now and this is one nine nine 201 went away now for a straight forward you're gonna have level two it'll be nine nine - OH - and 99212 for low it'll be nine nine 203 and nine nine two one three and I'm gonna show you that in the source document later but basically now your levels are gonna line up so if you have level two it'll be the same level of decision-making for new versus establishing and I'm going to show you this when I show you the source document you'll see how much neater this is going to be it's just gonna be a lot cleaner neater okay and there is a risk table like tool that you can use to that you will be using to do your MDM leveling so I'm just doing a real quick video of the tool right here so you can see it we will go to the source document and go through it in just a little bit but as you can see this is how you're going to select your levels based on this tool don't get too worried I am gonna give you the link to the source document in the video in the details underneath the video as well as I'm going to show you this in more detail at the end of the video so keep watching so that's medical decision making but fact number four is it now we can level based on time so like I told you there are two ways to level medical decision-making or time so two level based on time time alone can be used as I just said to select the level only four coats nine nine to zero two through nine nine two one five time may be used even if no your coordination of care so this is where we're that we're going away from the regular guidelines that you're used to used to be or it used to be currently if you want a level based on time there needs to be a statement about functional coordination of care and it has to be greater than 50% of the total time and all that has to be well documented in the record now time can be just the total time spent with the patient during the encounter for all other EMS this nothing changes it will stay the way it is currently and that's that you must document counseling and coordination of care to bill based on time all right and you're going to use the time descriptors in CPT to select your level and we're going to look at those when I show you the source document I'm gonna actually show you what the time the times look different now than they used to look so I'm going to show you that and you will use 92112 report time spent if you're supervising if you're a physician supervising clinical staff who provided face-to-face encounter all this is very well documented in the source document that I'm going to like I said give you the link to in the description below and I recommend very highly that you print it up get your highlighter out and your pens make lots of notes and be ready to explain this to your providers now you're going to report not for prolonged services we're no longer gonna report the old prolonged services codes for office visits for office visits if there's prolonged services we're going to be using that new code I told you about 9 9 X xx fat number 5 prolonged services are going to change so the the very first slide I was telling you that prolong services are some of the codes that will change and this is what's going to change about them you will no longer be using the prolong services codes for office visits instead they've added the code that I keep mentioning 9 9 X xx which apparently amuses me a lot and this is how you're going to use that code so if you haven't this is the new the at the top of the table you'll see the new patient if there's prolonged services and at the bottom of the table you'll see how to do an established patient if there's prolonged services so let's just kind of quickly go through it if you have a patient who say the provider spent eighty five minutes with and is a new patient you would build none on 205 times one unit and I'm not xxx times the one unit if it was an established patient that the provider spent let's say greater let's say let's don't do that let's say you spent the provider spent eighty four minutes with an established patient then you would bill nine on to one five times one and none 9 XX x times two all right so you guys are probably really excited I almost want to do like a drum roll here let's go out and take a look at the source document okay without any further ado here we are out on the source document that I have been teasing you about during the whole video you can google this it's on the AMAs website you can go out there and get it or you can just click on the link that I promised that I would put in the description below just to make it a lot easier I have copied I printed this up I have a copy on my desk that I'm I'm referring to I recommend that you do that if you're not one to kill trees and I felt totally respect that then you may want to save this on your desktop somewhere I've done both because I feel like I'm gonna need it more than once so I have copies of it I copy on my desk that's printed up and a copy saved to my desktop if you are a big OneNote user this is another document that'd be really cool to put in your OneNote so let's let's go through it they go first of all they're telling us this is effective 2021 and they're giving us all kind of information here they're telling us about time and how we're going to be using time and let's go through all right this part right here in the it starts in the read it says services reported separately I recommend that you read this very very carefully this is some stuff that as coders and auditors we've already been probably practicing but here it is in writing from the AMA and I would recommend that you take this very seriously and basically what they're saying in a nutshell here is because decision-making is going to be so important because you can level an entire visit based on decision making you cannot count for say a radiological report or a lab report in your medical decision making that your provider is going to build with a modifier 26 if you're in the case of an EKG if your provider can bill for that service and is going to build for that service you're not gonna count that as part of your test in your medical decision making as hem reviewing it you should not count it in both places you should not double dip that's this is basically saying pay attention not to double dip and give credit in MDM for something that you're going to build separately for okay so read that carefully make sure I'm telling you telling you correctly but that's important to note that you're they're telling us be careful not to double-dip this is where it goes in to explain in that the history an exam will be going away it does say that you still should be providing a medically appropriate history an exam but we will not be using that information as part of our decision-making or part of our level level choices now it does go into serious detail with these I definitely I can do a whole video on these definitions they go into very specific detail on what they mean when they say a problem what they mean when they say a problem that's a and you know what the provider has to do to address a problem what a minimal problem is versus what a self-limited or minor problem is versus what is a stable chronic illness what is a acute uncomplicated illness or injury and so forth this stuff will look very familiar to you because a lot of this stuff comes right off the wrist table but I recommend that you read these definitions very well to make sure that nothing has changed from the risk table that you're currently very comfortable and used to using I will tell you you want to look at where it talks about what the tests are and it says tests would be considered imaging labs psychometric physiological data it goes specific about how if it's a panel it's only counted as a single test a lot of this stuff is kind of common for coders but we want to make sure our providers understand this and we want to make sure that as coders that we are following these guidelines it talks about what what our external records what our external physicians it talks about who is an independent historian and what is an independent interpretation which is a good thing to pay close attention to that and this one is very important to note they go into detail about the drug therapy requiring intensive monitoring for toxicity and I know from being an auditor that coders and auditors debate this and they do a lot of research on this you know we go out to the max and we see what the max say about this and all this but the AMA has actually put a really good statement here saying that the monitoring it tells you kind of what it means by intensive why what makes it intensive and that the monitoring is for toxicity of a drug not for efficacy so we're not monitoring when the provider is doing monitoring of a drug they're not monitoring the drug to see if the drug is effective they're monitoring the drug to see what kind of side effects is causing in the patient in that is the you know they're telling make sure they're telling us make sure you understand the difference between monitoring for city versus monitoring just to see if the drug is working and they give some really good examples they give some examples that you will see in you know real coding life which I appreciate like down at the bottom they say examples of monitoring that do not qualify include monitoring glucose levels during insulin therapy as the prime as the primary reason is therapeutic effect so what you're doing when the doctor is monitoring insulin glucose levels if the patients getting insulin they're just seeing if it's working that's normal monitoring it has nothing to do a toxicity alright so I suggest you pay very close attention to that because medical decision-making leveling is you know you're gonna have to be very accurate with it we can't just like fly by the seat of our pants do a medical decision making when that is if you're you know you're facing your entire iam level on decision-making you need to make sure you're following these rules correctly because it's no longer two of three situation with an with an office visit it is you know one of one is that is the medical decision making at the level it needs to be or was the time documented those are the two things you're going to look at you know so and that's where these in this this section here I definitely recommend you you read these instructions where it starts with the red where it says instructions for selecting a level of office or other outpatient am service they're basically telling you what I've already said and that you're gonna choose your level based on either medical decision making or time and then they go into detail on how to level based on medical decision making step by step what you should be looking for right so to pay very good attention to this this is very important and then we get to this what I call risk table looking tool if you'll notice on the far left column it'll give you the code and this is the part that I think is so neat since they got rid of nine nine 201 your levels line so straightforward is a level two whether it's established or whether it's new and this is so cool I'm I've been waiting for them to do this level a low is a level three regardless of whether it's established or new and so forth and you'll look at level four and level five fantastic they're only those four levels and they line up perfectly with each other I love it love it love it and then if you come across after it tells you let's say let's go back down here straight forward then it'll tell you you've got your columns so you've got your type of medical decision making or your level and it's based on two of the three elements of MDM now the elements are the last three elements on the the last three columns so your elements are number and complexity of problems addressed amount and or complexity of data to be reviewed and analyzed and it says each unique test or order or document contributes to the combination of two or combination of three in category one below so if you go seeing that they're your categories category 1 category 2 and then if you've got your last element of medical decision-making is the risk of complications and or morbidity or mortality of patient management and so literally what you're gonna do is you're gonna go and you're gonna plot it all out on this chart and you're gonna you're gonna go with two of three so you'll go with you know the two of three so if you have two in a row that row will be say you have two in a row for low it'll be low if you have them spaced out then you'll I'm assume go with the middle one and see if they say okay yet must meet or exceed okay so to qualify for a particular level of medical decision making two of the three elements for that level of medical decision-making must be met or exceeded so that's how you would do it look so let's think med met or exceeded if you have one in low one in minimal yeah so you would go with the middle one if you have them if you have three different levels let's say you have a minimal in column one and you have a limited in column two and you have a moderate in column three then you would go with the low you would you would go this limited here you would go with none and two or three so I promise you there'll be upcoming video where we actually take a fake or redacted medical record and we do one of these level use we level it using the e/m so you guys can see what that looks like as a matter of fact I'm going to ask you if you have an example that is completely redacted has absolutely no patient information on it I would like you to send that to me at Angie at Angie decoder comm and I will be happy to do a video on it remember it has to be an office visit okay so send me if you have an office visit that is totally redacted and has no HIPPA on it then please send that to me at Angie it's the email addresses Angie and Angie decoder calm and I'll be happy to do a video using your example and we will level it using this alright so that's how to do that's how to level based on medical decision making just the nuts of it you know just the the bare bones of it so you can see it now let's get into the rest of the document this my my lovely coders this is a sneak preview can't talk today of what your codebook is going to look like in 2021 I'm sorry I get excited I mean it is April and we get a sneak peek of the codebook heck yeah I'm excited as you can see we have a bunch triangles Fred new patients if you you look you'll have you have the green text that says now none 201 has been deleted then you have all these greens triangles which mean that hey we've changed these descriptions and as promised look I told you the time is changing see what it says fifteen to twenty nine minutes of total time spent on the date of the encounter so there you go in that cold and then establish patient look at all the triangles look at all the changes and your time is totally different than it used to be I'm pretty sure it looks totally different oh and then I want you to look at the bottom of nine two one five it says for service is 55 minutes or longer see prolonged services code nine XXX nine nine xxx it also says that on the bottom of nine and two or five and then it gives us a preview of what the prolonged services code is going to look like in the code book now notice in the parentheses at the top and red where it says except these are your prolonged services code with direct patient contact except with office or other outpatient services so yeah and then if you come down here to here this is where they give you your non non xxx code and it gives you you know this is what it's gonna say in CPT about that code it tells you that you can only use it in conjunction with 99205 and nine nine two one five and then and you can see it's a red it's a red circle so that means it's a new code and there's the little chart that I showed you guys that I definitely recommend that you might want to print that up if you don't print anything else up if your providers tend to use prolong services codes in the office so there you go my lovely coders there is your your very quick and dirty sneak preview of what the stock looks like now aren't if you guys haven't already looked at it aren't you excited to go out there and check it out aren't you excited to print your own copy of this thing and and dig into it and you probably can't wait to tell your providers that everything they've heard about the changes is not really a hundred percent accurate and you you they're expert you now have the source document and you're ready to explain to them what they need to do differently and what they need to prepare themselves for going into 2021 so there you go okay so those are the changes what do you guys think do you like on is it as bad as you thought it was is it better than you thought it was are you looking forward to it I'm kind of looking forward to it I think it's gonna be kind of cool and anyway if you want us to do an example cuz I think it would be fun to code an example send me a redacted note in Angie my email address is Angie at Angie decoder comm let me say that again cuz that came out all wrong Angie at Angie the cutter comp like I said we'd act it makes sure there's no HIPAA information on it and sent it to me and then we will do another video where I share one of your examples and we try to code it together how does that sound so if you like what I'm doing give me a thumbs up really love that I really appreciate that what I like even better is hearing from you guys so if you have any comments questions observations or any suggestions for future videos please put that in the comments down below don't forget that in the description is where you can always find the links to whatever I discuss in the videos and hope you guys have a great day see you later