2023 E&M Coding Guideline Changes

NextGen® Ophthalmic Suite Help 2022.2

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. 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 professionals 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 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 NextGen® Ophthalmic Suite, the sy

NextGen® Ophthalmic Suite Help 2022.2

Finalize Tab for Ophthalmic Providers

You can calculate E&M coding and submit charges to billing on the Finalize - OPH template. In Ophthalmology, providers can choose to use the '97 or the 2021 E&M Code calculation or one of the codes specific to Ophthalmology referred to as Eye Codes. Prior to submitting codes to the Superbill, you can link procedures to an appropriate diagnosis, and select whether to bill for an encounter that was procedures only or an encounter where no procedures were performed. You can review E&M coding calculations and override, if appropriate, and bill for counseling services. Effective January 1, 2021, the E&M code is automatically selected based on the 2021 E&M Coding Guidelines, in which Medical Decision Making (MDM) complexity level or the total time spent with patient care and documenting the encounter is used to determine the code level. For more information about practice settings for E&M Coding on the Practice Configuration practice template, go to NextGen Healthcare Success Community and d

NextGen® Adaptive Content Engine Help Enterprise 8

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. 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

NextGen Behavioral Health Suite Help 5.5

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 u

NextGen® Adaptive Content Engine Help Enterprise 8

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 forNextGen®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 Nurse

2023 E&M Coding Guideline Changes

Recommendations

2021 E&M Coding Guideline Changes

Finalize Tab for Ophthalmic Providers

Evaluation and Management Coding Under 2021 Coding Guidelines

Evaluation and Management Coding

Behavioral Health E&M Coding Guidelines

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

2021 E&M Coding Guideline Changes

Finalize Tab for Ophthalmic Providers

Evaluation and Management Coding Under 2021 Coding Guidelines

Evaluation and Management Coding

Behavioral Health E&M Coding Guidelines

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