We are all excited about the upcoming 2023 E/M changes, aren't we? Well, I can say, as a coder and auditor, I am! I've been in this E/M world for about 35 years. Things were easy prior to 1995, right? Providers just documented the visit, no elements to make sure they included. But 1995 started to put providers in a "cage" of sorts. They now have to make sure that they include appropriate history, exam, and medical decision-making. Then, let's worry about new or established patients. Miss one element and go back on your level – sounds to me like a game of Chutes and Ladders! Can you imagine how frustrating this is for our providers? All they want to do is take care of their patients, not count how many ROS were included. 1997 brought more changes that worked great for specialty physicians, but primary care providers were put into an even smaller "cage." So we played the "Coding Chutes and Ladders" with two sets of rules – whichever worked best in each given situation. Talk about confusing to our providers who, most of the time, received no training on coding during their residency!
Now fast forward to 2021, we have changes, but only to 99202-99215. This is great for the office-based providers, but what about those providers seeing patients in both the inpatient and office setting? We are still at two sets of rules, but I believe the office-based physicians have done a good job of regressing to assessment and plan and not worrying about clicking boxes to meet criteria in the office setting.
One more fast forward, this time to January 1, 2023, where we put all providers on the same playing field with MDM or time (except for ED and critical care). We need to begin auditing and offering follow-up education now! The providers who offer inpatient services will need to think in a new mindset. No more clicking history and exam elements to determine the level of care. We need to ensure the documentation for the assessment and plan are rich with details to support medical necessity.
Back to Chutes and Ladders – remember, the point of that game is to go up the ladders without the chutes taking us back to the beginning. Here are a few "game changers" to put our providers on the winning side:
- Create tip sheets to share with providers that are short and concise nuggets and one sheet out every week or every other week. (Little pieces are more digestible than expecting them to learn it all in one setting.)
- Offer positive, not only negative, feedback.
- Be sure to include all staff who will be affected – nursing, coding, billing, authorization staff…who else?
- Utilize tools through NAMAS that will put providers at ease during this transition!
I'm excited (if you can't tell) for these changes to occur. I believe it will put providers back in the driver's seat to document those relevant pieces of information and focus on patient care.
Brenda Edwards, CPC, CDEO, CPB, CPC-I, CEMC, CRC, CMRS, CMCS. Brenda has been involved in the healthcare arena for more than 30 years with experience in chart audits, coding and billing, education, consulting, practice management, and compliance. She has worked closely with practices, providers, and residency programs to ensure documentation is compliant and accurate. Edwards has written many articles for national publications and associations, including Healthcare Business Monthly, the American Academy of Family Physicians, and BC Advantage. Her humorous and engaging presentation style has made her a conference favorite at both national and regional conferences.
NAMAS delivers preparation classes for the AAPC CPMA® exam, as well as continuing education opportunities for medical auditors. Other professionals, such as coders, practice managers, physicians, mid-level providers, and compliance officers, find our educational programs extremely beneficial in improving the effectiveness of their work.
