Evaluation and Management Coding Under 2021 Coding Guidelines

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Overview of Evaluation and Management Coding

You can calculate and submit the E&M code. You can submit and calculate the Evaluation and Management (E&M) code from the Finalize template using the 95, 97, 2021 Guideline, or 2023 Coding Guidelines update based on the Practice Configuration template settings. The available E&M codes vary by specialty and visit type. If you do not want to charge a patient encounter, you can select the No Charge Visit checkbox in the Evaluation and Management Coding panel to submit a no-charge code. The No Charge Visit procedure group checkbox is configured by default. The No Charge Visit checkbox is available only if the no charge SIM code is configured to the No Charge Visit procedure group using the Manage Procedure Group and Codes template. For more information, go to NextGen Healthcare Success Community, and download the Manage Procedure Groups and Codes Practice Template for NextGen® Adaptive Content Engine. The 95 and 97 Coding Guidelines use the following E&M code calculation criteria: History

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Enter the 2021 Coding Guidelines Effective Date for FTS and Ophthalmology Finalize Templates

For the FTS Finalize or Ophthalmology Finalize template, you must enter the effective date for the 2021 Coding Guidelines in a template you open from the EM Coding section of the Ngkbm Config template or the Practice Configuration template. You can set a date prior to the actual effective date for testing purposes. From the File menu, click System\Practice Template. The Select Template window opens. Click the Practice tab. In the Show section, select All. A list of practice-level templates appears. Do one of the following: For NextGen® Adaptive Content Engine, 8.4 to 8.4.1, click ngkbm Config, and then click OK. The Ngkbm Config template opens. For NextGen® Adaptive Content Engine, 8.4.2 and above, click Practice Configuration and then click OK. The Practice Configuration template opens. EM Coding 2021 Coding Guidelines link In the third column, click the 2021 Coding Guidelines link. The EM 2021 Date Config template opens. EM 2021 Date Config template Enter the effective date and then

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Submit E&M Codes under 2021 Coding Guidelines on the FTS Finalize Template

Before you begin To submit an E&M code, you must have selected an assessment in the Today’s Assessments panel. For more information on assessments, go to NextGen Healthcare Success Community and download the latest Getting Started User Guide for NextGen® Adaptive Content Engine. Open the Finalize template and expand the Evaluation and Management Coding panel. Evaluation and Management Coding To use a calculated E&M code, review and select the MDM level or enter the total time. For more details, see Calculate an E&M Code under 2021 Coding Guidelines on the FTS Finalize Template. The Medical Decision Making section displays the prepopulated MDM level based on the calculated levels in the three tables in the Medical Decision-Making Elements panel. To bypass or override the calculated code, select an E&M code in the code option section at the bottom of the Evaluation and Management Coding panel. Note: Code 99201 cannot be selected. The code expires effective January 1, 2021. Code 99211 Nur

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Submit E&M Codes under 2021 Coding Guidelines on the Ophthalmology Finalize Template

Before you begin To submit an E&M code, you must have selected a diagnosis. For more information on diagnoses, go to NextGen Healthcare Success Community, and download the latest Getting Started User Guide for NextGen® Adaptive Content Engine.Note: You can override the code from the EM 2021 Guidelines template by selecting another code directly from the Ophthalmology Finalize template. However, this selected code will not fall under the 2021 Coding Guidelines, and the calculated code from the EM 2021 Guidelines template still appears in the Calculated code field. You cannot select eye codes and E&M codes together. If you select an eye code, it overrides the E&M code. Open the Ophthalmology Finalize template and expand the EM Code panel. Enter counseling and educational details and factors. Enter additional visit codes and modifiers. You can add up to two modifiers for a visit code. Note: You cannot enter eye codes and E&M codes together. If you enter an eye code, it overrides the E&M c

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Applying 2021 Coding Guidelines on the Cardiology Finalize Template

If your practice has entered a 2021 Coding Guidelines Effective Date for Cardiology on the Ngkbm Config template or the Practice Configuration template, the following conditions apply to encounters on or after the effective date: The 2021 Coding Guidelines apply only to new patient visits or to return office visits. For these visit types, the EM 2021 Guidelines template calculates codes 99202-99205 for a new patient and 99211-99215 for an established patient. Note: Code 99201 expires effective January 01, 2021 and does not appear for a new patient. The 2021 E&M Coding Guidelines override any criteria your practice may have entered for new patient and return office visit types on the CARD Setup Visit Type template. If you select a non-custom visit type, the Cardiology Finalize template calculates E&M codes based on the 95 or the 97 Coding Guidelines selected on the Ngkbm Config template or on the Practice Configuration template. If your practice has set up custom visit types and entered

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Evaluation and Management Coding

NextGen® Adaptive Content Engine uses Evaluation and Management (E&M) coding guidelines from the Centers for Medicare and Medicaid Services (CMS) for the documentation and billing of E&M services because these protocols are the most stringent. CMS provides three sets of guidelines to calculate E&M codes: 1995 (95) Coding Guidelines 1997 (97) Coding Guidelines 2021 Coding Guidelines (effective January 1, 2021) The Cardiology template set does not use these calculation methods described. For information on E&M coding for the Cardiology specialty, go to NextGen Healthcare Success Community, and download the Cardiology User Guide for NextGen® Adaptive Content Engine. The 95 and 97 Coding Guidelines calculate E&M codes based on one of the following: Documented history and physical exam elements, and the selected Medical Decision Making (MDM) level Total visit time if more than 50 percent of the time spent counseling or coordinating care You can use either the 95 or 97 Coding Guidelines, dep

Evaluation and Management Coding Under 2021 Coding Guidelines

Recommendations

Overview of Evaluation and Management Coding

Enter the 2021 Coding Guidelines Effective Date for FTS and Ophthalmology Finalize Templates

Submit E&M Codes under 2021 Coding Guidelines on the FTS Finalize Template

Submit E&M Codes under 2021 Coding Guidelines on the Ophthalmology Finalize Template

Applying 2021 Coding Guidelines on the Cardiology Finalize Template

Evaluation and Management Coding

Evaluation and Management Coding Under 2021 Coding Guidelines

Overview of Evaluation and Management Coding

Enter the 2021 Coding Guidelines Effective Date for FTS and Ophthalmology Finalize Templates

Submit E&M Codes under 2021 Coding Guidelines on the FTS Finalize Template

Submit E&M Codes under 2021 Coding Guidelines on the Ophthalmology Finalize Template

Applying 2021 Coding Guidelines on the Cardiology Finalize Template

Evaluation and Management Coding