Wiki Auditing E/Ms based on 2021 changes

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heatherj

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I need clarity on how to move forward with audits. I audit office visits for a couple practices. I know that the guidelines have changed beginning in 2021, but I have seen that the 95 and 97 guidelines can still be used by providers. If providers are using these guidelines, and the patient has a commercial insurance (bcbs), am i auditing based on those guidelines or according to the 2021 guidelines.
 
file:///C:/Users/tmckinney/Desktop/Billing%20&%20Coding%20Education/E&M%202021%20Coding%20Guidelines.pdf

I hope you can open this link, but if not, try Googling, The Devil in the Details E &M Coding in 2021. This section answers your question nicely, I think.
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According to some of what I have read. The provider can still follow the template of gathering that information, but when it comes to determining the level, it will either be by TIME or MDM only.
 
heatherj said:
I need clarity on how to move forward with audits. I audit office visits for a couple practices. I know that the guidelines have changed beginning in 2021, but I have seen that the 95 and 97 guidelines can still be used by providers. If providers are using these guidelines, and the patient has a commercial insurance (bcbs), am i auditing based on those guidelines or according to the 2021 guidelines.
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Heather, We are trying to ensure we have well documented notes for 99212/99213/99214. Do you happen to have a sample note that you could provide to help our office do better with documentation? We are not sure where to start and want to ensure we are hitting every bullet point in out note that is required
 
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