View E&M Summary and 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

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 Behavioral Health Suite Help 5.6

Submit E&M Codes per the 2021 Coding Guidelines

You can submit a calculated or selected Evaluation and Management (E&M) code to the Superbill using the 2021 Coding Guidelines. Before you begin The date of the encounter must be on or after the effective start date entered for the 2021 Coding Guidelines on the Practice Configuration template. The visit type must be one of the visit types impacted by the 2021 guidelines. For more information on the 2021 Coding Guidelines, go to NextGen Healthcare Success Community, and download the E&M Coding User Guide for NextGen® Adaptive Content Engine. Also, you must select an assessment in the Today’s Assessment panel to be able to submit an Evaluation and Management (E&M) code. For guidance on how to use the 2021 E&M Coding Guidelines based on Medical Decision Making (MDM) level and time, you can use the information Info Icon icon. For guidance on the level of complexity and risks involved in MDM, you can use the View MDM Guidelines link. From an encounter, select the Templates Template Icon ico

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Evaluation and Management Coding

You can configure the settings in the Evaluation and Management panel on the Finalize template using the E&M Coding section on the Practice Configuration template. 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 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

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

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 8.3.1

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

View E&M Summary and Coding Guidelines

Recommendations

Overview of Evaluation and Management Coding

Evaluation and Management Coding Under 2021 Coding Guidelines

Submit E&M Codes per the 2021 Coding Guidelines

Evaluation and Management Coding

Evaluation and Management Coding

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

Overview of Evaluation and Management Coding

Evaluation and Management Coding Under 2021 Coding Guidelines

Submit E&M Codes per the 2021 Coding Guidelines

Evaluation and Management Coding

Evaluation and Management Coding

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