New guidelines for office and other outpatient evaluation and management (E/M) codes (99202 -99215) took effect on Jan. 1, 2021. Beginning Jan. 1, 2023, all places of service utilize the revised E/M documentation guidelines. This includes Hospital Inpatient and Observation Care Services (99221-99223, 99231-99236), Consultations (99242- 99245, 99252-99255), Emergency Department Services (99281-99285), Nursing Facility Services (99304-99310For the entire family of E/M codes physicians must perform and document a “medically appropriate history and examination”. The appropriate level of E/M is based on the level of medical decision making or total time performed by the physician, including face to face and pre/post time on the date of the encounter*. When selecting based on medical decision making, two of three components (problem, data and risk) must meet or exceed the same level of complexity (straight-forward, low, moderate or high)*Exception – time is not a descriptive component of Emergency Department ServicesComprehensive training for documentation, medical decision making, and coding based on time is provided in chapter 4 of the Fundamentals of Ophthalmic Coding or Retina Coding: Complete Reference Guide. Medical decision making tables for both office-based and in-patient/emergency department services are provided in the resources below.If your practice bills E/M codes, you will need to understand the definitions and concepts in these guidelines. Here you will find Academy resources, courses and answers to questions all designed for your success.
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