Conquer E/M for Ophthalmology
New Guidelines Effective Jan. 1, 2023
Beginning Jan. 1, 2023, all places of service utilize the revised evaluation and management (E/M) documentation guidelines. This includes Hospital Inpatient and Observation Care Services (99221-99223, 99231-99239), Consultations (99242- 99245, 99252-99255), Emergency Department Services (99281-99285), Nursing Facility Services (99304-99310, 99315, 99316), and Home or Residence Services (99341, 99342, 99344, 99345, 99347-99350).
For the entire family of E/M codes physicians must perform and document a “medically appropriate history and examination”. The appropriate level of E/M is based on the level of medical decision making or total time performed by the physician, including face to face and pre/post time on the date of the encounter*.
*Exception – time is not a descriptive component of Emergency Department Services
Comprehensive training for documentation, medical decision making, and billing based on time is provided in chapter 4 of the 2023 Fundamentals of Ophthalmic Coding.
Medical decision-making tables for both office-based and in-patient/emergency department services are provided in the resources below.
EyeNet Savvy Coder article: E/M 2023 – Starting Jan 1, Streamlined Rules Apply Beyond the Office Setting
E/M Documentation Requirements That Took Effect Jan. 1, 2021
Documentation guidelines for E/M of new and established patient visits have not changed since 1997, but a new series of guidelines for office-based E/M codes took effect on Jan. 1, 2021.
If your practice bills for services using these types of codes, you will need to understand the new definitions and concepts in these guidelines. Here you will find Academy resources, courses and answers to questions all designed for your success.
Resources
- In this short video, Austin Retina Associates' CEO, Stephanie Collins and scribe supervisor, Amanda Turner, share employment strategies that help lay the groundwork for developing successful scribes within their organization.
- EyeNet Savvy Coder articles:
- Order the Academy's Fundamentals of Ophthalmic Coding book. Chapter 4 details Evaluation and Management and Eye visit code documentation.