For years, providers and coders alike have been forced to contend with evaluation and management (E/M) guidelines that leave a lot to be desired. For two full decades now, healthcare professionals have been forced to choose between two sets of rules, the 1995 guidelines and the 1997 guidelines, for E/M encounters. Unsurprisingly, the extra options have routinely produced as much confusion as benefit, the result being that evaluation and management codes are the most commonly misused codes even today. In fact, some projections estimate that over 1,500 decision points must be analyzed and considered when coding a single E/M encounter. Thankfully, that may be soon to change.
Back in March 2016, CMS received letters from ten prominent medical societies, all urging for a change in E/M documentation. According to these letters, CPT codes 99201-5 and 99211-5, both used for low-level E/M visits, “no longer accurately or adequately reflect the work currently provided to and required by Medicare beneficiaries.” By way of response, CMS recently released its 2018 fee schedule, within which it “promises to consider” reform to the evaluation and management guideline system.
Though such vague words may not mean much at first, CMS began asking for feedback on how to improve the guidelines, while also hinting at possible future changes, such as an elimination of the requirements for the history and physical exam. Soon after, HHS released a statement saying “Now that EHRs are online, we see how the two (EHRs and E/M coding guidelines) create even more problems: we get voluminous, sometimes nonsensical health notes that can be unreadable or make it difficult to determine where the real information is.” With two major organizations ostensibly on board for a major change, hopefully evaluation and management codes and documentation will soon see the improvement they have needed for so long.