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The Impact of 2021 E&M Coding Changes to Physician Practices

CMS is making the biggest changes since 1997 to Evaluation and Management Coding. These changes go into effect on January 1, 2021. The 3 biggest changes are:

  1. These changes apply to New & Established Office Visits and outpatient codes (99201-99215).
  2. 99201, New Patient Visit Level 1 is being retired.
  3. Level of service will be determined by time or medical decision making, not history and examination.

The big picture objective from CMS driving these coding changes is part of the Patient's Over Paperwork objective. For more details on preparing for the E&M Coding Changes, both AAPC and AMA have excellent documentation and training materials for clinicians and coders.

An often overlooked impact of these changes is Rev Cycle Productivity and Staffing in the short term and long term, which we analyze below.

Short-Term Impact: Loss in Productivity

In order to prepare for the new coding changes, practices are spending extra time on physician education. Revenue cycle staff is likely spending hours studying up on the changes, assisting in training, and preparing their coding technology with new rules to handle the changes. Many practices will likely hire new coding staff, or otherwise fall behind and undergo extreme charge lag during the transition phase.

Top-performing practices in EPH, a revenue cycle productivity metric, will be able to handle the changes without hiring more staff. These practices can get through the transition period with less of a drop in productivity because they are able to do more with less in the revenue cycle. Learn more about this metric by downloading our free eBook, What the Heck is EPH?!

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Long-Term Impact: Potential Productivity Increase

The changes that CMS has laid out are meant to ease the burden of documentation for providers. The E&M coding changes should make it easier for both providers and coders to select the correct visit level for encounters, and providers are no longer required to re-document things that do not change from visit to visit. Time will tell if these changes truly impact the productivity and burden on physicians and coders alike.

Bottom Line:

The productivity impact will be most severely felt in the short term, but long term should provide time savings and reduced "paperwork." All practices will feel the near-term productivity decline as they adapt to the change, but elite performing practices on EPH will be the fastest to get through the transition time and emerge with a smaller, more productive coding team than average performers.