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    Veronica Bradley
    Veronica Bradley, CPC, CPMA

    Getting paid for some of the most routine outpatient office visits became a new challenge on Jan. 1, 2021, when guideline and code descriptor changes for E/M services — previously announced by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) — take effect.

    Specifically, office or other outpatient E/M codes 99202 through 99215 are being updated along with the elimination of code 99201 (due to low utilization).

    Article: 2021 E/M changes explained

    Most importantly, the methods of selecting code levels via medical decision making (MDM) will change along with the codes. To help make sense of this signficant update for these codes, MGMA has assembled a downloadable tool to outline:

    • The level(s) of each E/M code
    • The time elements for each code
    • Details on the number and complexity of problems addressed to help establish MDM
    • The three categories addressing amount and/or complexity of data to review and analyze
    • Risk levels for complications and/or morbidity or mortality of patient management.
    Download: Medical Decision Making for Outpatient E/M Codes (PDF)

    Additional resources

    Learn more

    • MGMA Consulting — Get an organizational tune-up with the help of our MGMA Consultants.
    • MGMA Chart Audit Services — Our team of coders employs more than 35 years of institutional knowledge of coding to create personalized experiences that not only teach but lead your team through practices of establishing accurate coding. 
    Veronica Bradley

    Written By

    Veronica Bradley, CPC, CPMA

    Veronica Bradley, CPC, CPMA, has more than 20 years’ experience in medical coding and auditing in various specialties. She is also well-versed hierarchical condition category and risk adjustment coding. Other areas of expertise include E/M, procedural coding, Medicare reimbursement and other critical factors in coding and auditing. Veronica has worked in private practice, group practices, academic school of medicine and hospitals. Veronica received a bachelor’s degree in health information management and a minor in healthcare administration from Regis University in Denver.

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