2021 E&M Coding Guideline Changes

Effective January 1, 2021, Evaluation & Management (E&M) coding is based on Medical Decision Making (MDM) or time. History and physical exam elements are not used in the 2021 coding calculations. The established patient code 99211 is used for nurse visits.

In NextGen® Ophthalmic Suite, the system is able to calculate visit codes based on the current E&M coding guidelines or the new 2021 E&M coding guidelines. On the Practice Configuration practice template, the 2021 Coding Guidelines Effective Date field lets you set the date to begin using the 2021 E&M guidelines for calculating E&M visit codes for new office visit encounters. 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. By default, Ophthalmology uses 1997 Coding Guidelines for encounters and visit types.

In the EM Code panel, 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. If you wish to use the Eye Codes for billing, you must manually select the appropriate code listed in the Eye Codes section.

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 latest Practice Configuration Template User Guide for NextGen® Adaptive Content Engine and the E&M Coding User Guide for NextGen® Adaptive Content Engine.