The Centers for Medicare & Medicaid Services (CMS) updated its Evaluation and Management (E/M) Services guide, including changes from previous years. These updates have a broad-reaching impact, affecting areas such as:
- Hospital inpatient and observation care
- Home or residence visits
- Nursing facility encounters
- Emergency department (ED) services
Effective January 1st, CMS revamped the documentation guidelines for E/M services across these settings. These changes align with the 2021 updates to office visit E/M guidelines, making it easier for clinicians to select the appropriate service level.
Now, they can typically choose between medical decision-making (MDM) and total time spent on the day of the encounter. However, for ED services, the choice relies solely on MDM. Total time calculation now includes face-to-face and non-face-to-face time invested by the physician or qualified healthcare professional on the service date.
While a medically appropriate history and physical exam remain essential, they are no longer the primary factors determining the service level.
It’s also worth noting that CMS closely aligns with the American Medical Association’s CPT E/M code descriptors and guidelines. However, there are notable differences, particularly in billing for prolonged services. The updated guide now provides comprehensive guidance on coding for prolonged services for Medicare patients. It also includes a helpful table outlining the time thresholds for each prolonged service code.
Additionally, the revised guide offers valuable insights into billing for critical care, split/shared services, chronic pain management, and teaching physician services. These updates signify CMS’s commitment to simplifying the billing process while maintaining quality patient care standards.
Stay tuned for more insights and updates as these changes continue to shape the healthcare billing landscape. Subscribe to our Health Prime blog for medical billing best practices, ongoing industry news, and policy updates.
Click below to read the complete Evaluation and Management (E/M) Services guide: