2021 EM Coding Guidelines - Our Plan

2021 EM Coding Changes - iSalus Healthcare's Plan

On January 1st, 2021, the new rules related to billing for Office Visits will drastically change.  The new rules are intended to simplify and streamline the coding and documentation for E/M office visits, making them clinically relevant, and reducing excessive administrative burden.

Major Changes to EM Coding

Key elements of the E/M office-visit overhaul include:

  • Eliminating history and physical exam as elements for code selection. While significant to both visit time and medical decision-making, these elements alone should not determine a visit’s code level.
  • Allowing physicians to choose whether their documentation is based on medical decision-making or total time. This builds on the movement to better recognize the work involved in non-face-to-face services like care coordination.
  • Changing medical decision-making criteria to move away from simply adding up tasks to instead focus on tasks that affect the management of a patient’s condition.

Changes to OfficeEMR

To support these changes, iSalus Healthcare will be modifying the EM Coding module in OfficeEMR. 


The current EM Coding rules require 3 elements - History, Exam, and Medical Decision Making

The new EM Coding rules only require Medical Decision Making.  The History and Exam portions will be removed.

The current EM Coding engine integrates with templates such as History of Present Illness, Review of Systems, and Exams to help determine coding level.

The new EM Coding rules do not take into account History, HPI, ROS, or Exam data points.  Therefore, no integration with templates will exist.

The current EM coding engine provides guidance on the Medical Decision Making portion of the rules - users are required to select the various levels of complexity that exist for the desired patient to obtain a recommendation. 

The Medical Decision Making portion of the EM Coding rules engine will be updated with the new guidance provided by CMS.

The current EM coding engine allows for time based billing use the legacy standards and timing guidance.

The EM Coding engine will be updated to use the new timing requirements for 2021.  Users can choose to bill based on MDM or time when selecting the visit level.

Learn how the EM Coding Engine works here: EM Coding

Dig Deeper

In addition to the above changes being made by iSalus Healthcare, we strongly encourage all practices to dig deeper into the new regulations to prepare for this major change.

Learn more about the 2021 Fee Schedule Updates

The 2021 fee schedule is changing for more than just office visits. There are several other changes worth reading into.  Check out the CMS Final Rule Overview here: https://www.cms.gov/newsroom/fact-sheets/proposed-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-4.

Procedure Code Updates

The AMA will be updating and removing some procedure codes and the language around what those codes mean.  Practices using OfficeEMR are responsible for maintaining their own procedure codes and fee schedules.  We suggest you review the procedure codes that you have currently setup in OfficeEMR and update as you see fit.  Procedure codes can be reviewed and changed by navigating to Setup > Procedure Codes. 

Superbill Template Updates

Once you have updated your procedure codes, it may also be helpful to modify the Superbill Templates used in the EMR by the medical team.  Superbills can be reviewed and changed by navigating to Setup > Superbill Templates.

EMR Template Updates

After reviewing the new billing rules, you may decide to have templates in your system modified to take advantage of the streamlined documentation requirements.  Template Change requests can be made by contacting support@isalushealthcare.com.