Overview of Evaluation and Management Coding

NextGen® Adaptive Content Engine Help Enterprise 8

Submit E&M Codes under 2021 Coding Guidelines

You can submit a calculated or selected E&M code to the Superbill using 2021 Coding Guidelines. Before you begin The encounter must be on or after the effective start date of 2021 Coding Guidelines entered on the Practice Configuration template. The visit type must fall under the guidelines. For more information on 2021 Coding Guidelines, go to NextGen Healthcare Success Community, and download the latest E&M Coding User Guide forNextGen®Adaptive Content Engine. You must select an assessment in the Today’s Assessments panel to be able to submit an E&M code. Open NextGen® Enterprise EHR. For a patient record, open a new encounter. Open the Finalize template. On the Evaluation and Management Coding panel, to use a calculated E&M code, review and select the Medical Decision Making (MDM) level or enter the total time. The Medical Decision Making section displays the MDM level based on the calculated levels in the three tables in the Medical Decision - Making Elements panel. Evaluation and

NextGen® Adaptive Content Engine Help Enterprise 8

Submit E&M Codes under 95 or 97 Coding Guidelines

You can submit a calculated or selected E&M code to the Superbill under the 95 or 97 Coding Guidelines. Before you begin You must select an assessment in the Today’s Assessments panel to submit an E&M code. Open NextGen® Enterprise EHR. For a patient record, open a new encounter. Open the Finalize template. Expand the Evaluation and Management Coding panel. Evaluation and Management Coding To use a calculated E&M code, you can select the MDM level, or enter the total visit time. Enter any additional visit codes. To meet visit code criteria for Quality Reporting, select a SNOMED CT code. To override the calculated code, select an E&M code in the code options section at the bottom of the Evaluation and Management Coding panel. Note: The 99201 code cannot be selected as the code has expired on January 1, 2021. To generate a note, referral, lab order, requisition, or another document, select Generate Note and select an option. Select Submit Code. The code appears in the Submitted field. Th

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

Patient's General Information on Finalize

You can view the general details related to finalizing the workflow of the patient in the General panel. In the General panel, you can do the following: View the patient type. If other encounters exist for the patient, the Established patient option is selected, and if no other encounters exist, then the New patient option is automatically selected. You can also change the selected patient type. The calculated E&M codes are based on the patient type. View the type of guidelines (1995, 1997, or 2021) selected for Evaluation and Management (E&M) coding. Access information on E&M guidelines for 1995 or 1997 from the Centers for Medicare and Medicaid Services (CMS) website, and for 2021 from the American Medical Association (AMA) website using the Web button. Select the physical exam type for multiple systems or a single system, if you enabled the 97 Coding Guidelines on the Practice Configuration template. In the General panel, if you select Single system, you need to select an exam type.

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

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

Overview of Evaluation and Management Coding

Recommendations

Submit E&M Codes under 2021 Coding Guidelines

Submit E&M Codes under 95 or 97 Coding Guidelines

Evaluation and Management Coding Under 2021 Coding Guidelines

Patient's General Information on Finalize

Evaluation and Management Coding

Evaluation and Management Coding

Overview of Evaluation and Management Coding

Submit E&M Codes under 2021 Coding Guidelines

Submit E&M Codes under 95 or 97 Coding Guidelines

Evaluation and Management Coding Under 2021 Coding Guidelines

Patient's General Information on Finalize

Evaluation and Management Coding

Evaluation and Management Coding