NextGen Knowledge Center

Behavioral Health E&M Coding Guidelines

To submit a calculated or a selected Evaluation and Management (E&M) code from the Finalize template, you can use 97 or 2021 E&M coding guidelines configured on the Practice Configuration template. The available E&M codes vary by specialties and visit types.

The 97 E&M Coding Guidelines calculate the E&M code based on one of the following:
  • History and physical exam elements that were documented on templates and the Medical Decision Making (MDM) level selected
  • Total visit time if more than 50 percent of the time was spent counseling or coordinating care
When you enter the effective date in the 2021 Coding Guidelines Effective Date field on the Practice Configuration template, you must also select either the 97 Coding Guidelines for use with visit types and encounters that do not fall under the 2021 E&M Coding Guidelines. The current E&M coding guidelines will be in effect until the set date. You can set any date, change, or remove the date at any time. NextGen® Behavioral Health Suite uses 97 Coding Guidelines for encounters and visit types not impacted by the 2021 Guidelines.

If your practice defaults visit types based on Program to or has selected one of the following visit types prior to accessing the Finalize (BH) template, then the 2021 E&M Coding Guideline updates apply:

  • After Hours Visit
  • Annual Post Op
  • Chemotherapy
  • Colposcopy Visit
  • Coumadin Visit
  • Dialysis Visit
  • Endometrial Bx Visit
  • Family Consultation
  • Fracture FU (billable visit)
  • General Medical Exam
  • GYN Visit
  • Initial fracture care
  • Medical Clearance, Visit
  • Medication Management without Psychotherapy
  • Medication Management with Psychotherapy
  • Medication Management with Psychotherapy & Translator
  • Mohs Surgery Visit
  • New Patient
  • OB Prenatal - Initial
  • Office Visit
  • Office Visit - GYN
  • Office Visit - OB
  • Pessary Visit
  • Onsite Consult
  • Pre Op Visit
  • Psychotherapy - Individual with E&M
  • Return Office Visit
  • Urgent Care Visit
  • Consultation
The 2021 Coding Guidelines calculate E&M codes based on one of the following:
  • MDM level selected
  • Time- Total time spent on patient care and documentation for the visit, which includes the face-to-face time with the patient and other time personally spent by the physician and/or other qualified healthcare professional on the day of the encounter.
You can include counseling time in the total time, but the 2021 guidelines do not require that over 50% of the total time be spent in counseling or coordinating care. The 2021 E&M Coding Guidelines apply to certain visit types that use codes 99202-99205 for a new patient and 99211-99215 for an established patient. Code 99201 expires effective January 1, 2021.

In the EM Code panel, you can submit an E&M Code based on the MDM complexity level or the total amount of time spent on patient care and documentation for the encounter. The appropriate office visit code is automatically selected and appears in the Calculated code field. The Prolonged Service field populates the prolonged service code, 99417, with appropriate units based on the type and the Time documented in the Medical Decision Making/Counseling panel.

For more information about practice settings for E&M Coding on the Practice Configuration practice template, go to NextGen Healthcare Success Community and download the Practice Configuration Template User Guide for NextGen® Adaptive Content Engine and the E&M Coding User Guide for NextGen® Adaptive Content Engine .

Related tasks
Submit E&M Codes per the 2021 Coding Guidelines