October 28, 2022 | By Brenda Edwards, CPC, CDEO, CPB, CPC-I, CEMC, CRC, CMRS, CMCS
We are all excited about the upcoming 2023 E/M changes, aren’t we? Well, I can say, as a coder and auditor, I am! I’ve been in this E/M world for about 35 years. Things were easy prior to 1995, right? Providers just documented the visit, no elements to make sure they included. But 1995 started to put providers in a “cage” of sorts. They now have to make sure that they include appropriate history, exam, and medical decision-making. Then, let’s worry about new or established patients. Miss one element and go back on your level…sounds to me like a game of Chutes and Ladders! Can you imagine how frustrating this is for our providers? All they want to do is take care of their patients, not count how many ROS were included. 1997 brought more changes that worked great for specialty physicians, but primary care providers were put into an even smaller “cage.” So we played the “Coding Chutes and Ladders” with two sets of rules – whichever worked best in each given situation. Talk about confusing to our providers who, most of the time, received no training on coding during their residency!
Now fast forward to 2021…we have changes BUT only to 99202–99215. This is great for the office-based providers, but what about those providers seeing patients in both the inpatient and office setting? We are still at two sets of rules, but I believe the office-based physicians have done a good job of regressing to assessment and plan and not worrying about clicking boxes to meet criteria in the office setting.
One more fast forward, this time to January 1, 2023, where we put all providers on the same playing field with MDM or time (except for ED and critical care). We need to begin auditing and offering follow-up education now! The providers who offer inpatient services will need to think in a new mindset. No more clicking history and exam elements to determine the level of care. We need to ensure the documentation for the assessment and plan are rich with details to support medical necessity.
Back to Chutes and Ladders – remember, the point of that game is to go up the ladders without the chutes taking us back to the beginning. Here are a few “game changers” to put our providers on the winning side:
- Create tip sheets to share with providers that are short and concise nuggets and one sheet out every week or every other week. (Little pieces are more digestible than expecting them to learn it all in one setting.)
- Offer positive, not only negative, feedback.
- Be sure to include all staff who will be affected – nursing, coding, billing, authorization staff…who else?
- Utilize tools through NAMAS that will put providers at ease during this transition!
I’m excited (if you can’t tell) for these changes to occur. I believe it will put providers back in the driver’s seat to document those relevant pieces of information and focus on patient care.
Your next steps:
- Contact NAMAS for information about customized staff and provider training.
- Read more blog posts to stay updated on the 2023 Revisions to the 2021 E&M Guidelines.
- Subscribe to the NAMAS YouTube channel for more auditing and compliance tips!
NAMAS is a division of DoctorsManagement, LLC, a premier full-service medical consulting firm since 1956. With a team of experienced auditors and educators boasting a minimum of a CPC and CPMA certification and 10+ years of auditing-specific experience, NAMAS offers a vast range of auditing education, resources, training, and services. As the original creator of the now AAPC-affiliated CPMA credential, NAMAS instructors continue to be the go-to authorities in auditing. From DOJ and RAC auditors to CMS and Medicare Advantage Auditors to physician and hospital-based auditing professionals, our team has educated them all. We are proud to have helped so many grow and excel in the auditing and compliance field.
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