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2021 E&M Coding Pearls from Your SGO Coding Committee

Coding ToolsCoding
Jan 28, 2021

Starting Jan. 1, 2021, selecting the level of outpatient Evaluation & Management (E&M) visit code to bill will be based on either time or medical decision making (MDM).

How is the level of MDM determined?

  • Number of diagnoses or management options
  • Amount and/or complexity of data reviewed
  • Risk of complications and/or morbidity or mortality

Understanding the definitions within the categories is key to correct coding. This month we take a closer look at chronic problems.

Chronic problems are those with an expected duration of one year. They may be further described as:

  • Chronic, stable
  • Chronic with exacerbation, progression or side effects of treatment
  • Chronic with severe exacerbation, progression or side effects of treatment
  • Use ICD10 to describe the related problems, for example: new sites of metastases, side effects of chemotherapy or radiation, menopausal symptoms.

For an in-depth look at the 2021 changes to E&M coding, please: