2021 E&M Coding Updates

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Evaluation and Management Coding Under 2021 Coding Guidelines

After you install the update package for NextGen® Adaptive Content Engine, you can perform Evaluation and Management (E&M) coding under 2021 Coding Guidelines for the FTS Finalize, Ophthalmology Finalize, and Cardiology Finalize templates. For information on installing the package, go to NextGen Healthcare Success Community and download the latest 2021 E&M Coding Updates Installation Guide for NextGen® Adaptive Content Engine. The 2021 Coding Guidelines calculate E&M codes based on one of the following: Medical Decision Making (MDM) level selected 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 professionals on the day of the encounter You can include counseling time in the total time, but the 2021 Coding Guidelines do not require that over 50 percent of the total time be spent in counseling or coordinating care. The 2021 Coding Guid

NextGen® Adaptive Content Engine Help Enterprise 8

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. Evaluation and Management Coding Overview of E&M coding guidelines Physical Exam Calculation for 95 Coding Guidelines Methods of physical exam calculations for the 95 Coding Guidelines Physical Exam Calculation for 97 Guidelines Multi- and Single-system exam types under the 97 Coding Guidelines Components of E&M Coding Description of the components used in E&M coding for the selected guidelines Related concepts Evaluation and Management Coding Physical Exam Calculation for 95 Coding Guidelines Physical Exam Calculation for 97 Guidelines Related reference Components of E&M Coding

NextGen® Adaptive Content Engine Help Enterprise 8

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 latest 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 was spent counseling or coordinating care You can use either the 95 or 97 Coding Guide

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2023 E&M Coding Guideline Changes

You can use the new Evaluation and Management (E&M) codes and guidelines that are effective from January 1, 2023. Most of the E&M codes from various visit types, such as Consult, Home Visit, Domiciliary Visit, Nursing Facility Care, Emergency Department, Inpatient, are now inclusive of 2023 E&M guideline. A few E&M codes such as Observation Care and Prolonged Service are removed and redirected to the existing visit type codes. The E&M code calculation logic is based on the patient encounter date (greater or equal to January 1st, 2023) and the selected visit type on the Finalize - OPH template. With the 2023 Coding Guidelines update, the 99241 code is disabled, and the labels for the following codes are updated in the Consultation section of the EM Code panel on the Finalize - OPH template: 99242: Straightforward 20-29 mins 99243: Low 30-39 mins 99244: Moderate 40 -54 mins 99245: High greater than 55 mins medical decision making/counseling template For more information about practice se

NextGen® Adaptive Content Engine Help Enterprise 8

Evaluation and Management Coding

You can use three types of guidelines to calculate the Evaluation and Management code for Cardiology. To submit a calculated or a selected Evaluation and Management (E&M) code on the Finalize - Cardiology template, you can use guidelines for 95, 97, or 2021 configured on the Practice Configuration template. The 95 and 97 Coding Guidelines calculate E&M codes based on one of the following. Previously documented history and physical exam details and the selected Medical Decision Making (MDM) level. Total visit time, if more than 50 percent of the time was spent counseling or coordinating care. The 2021 Coding Guidelines calculate E&M codes based on one of the following. The selected MDM level. Total time spent by medical professionals treating patients and documenting their care during the encounter, including the amount of face-to-face and other time they spend with patients. On the Practice Configuration template, if you select the 2021 Coding Guidelines, you must also select the 95 or

NextGen® Adaptive Content Engine Help Enterprise 8

E&M Coding

The E&M Coding section of the Practice Configuration template displays Evaluation and Management configuration options that apply to all specialties except Cardiology. The Cardiology-specific E&M settings are available in the Cardiology E&M Guidelines section of the Practice Configuration template. For more information on E&M coding, go to NextGen Healthcare Success Community and download the latest E&M Coding User Guide for NextGen® Adaptive Content Engine. In the E&M Coding section, you can configure the following settings: E&M Coding section Guidelines - You can select the coding guidelines to use for E&M coding on the Finalize template. You can select either the 95 Coding Guidelines or 97 Coding Guidelines. To use the 2021 Coding Guidelines, you must enter the 2021 Coding Guidelines Effective Date. If you enter a date, you must also select the 95 or 97 Coding Guidelines to cover visit types not affected by the 2021 guidelines or for encounters before the effective date. If you sele

2021 E&M Coding Updates

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