Preparing for the 2021 E/M code transition begins with education

KristinStewart_2018-1The 2021 Evaluation and Management (E/M) code transition, which went into effect on January 1, 2021, is yet another change that requires preparations by health systems. The E/M transition is specific to office and outpatient E/M services, changing both the documentation and coding requirements.

Qualified Healthcare Professionals (QHPs) are able to select the office visit level based on Medical Decision Making (MDM) or Total Time on the day of the encounter. In 2021, physicians are no longer limited to choosing time only when they spend more than 50% of face-to-face time counseling or coordination of care. They can now choose Total Time based on time spent the day of the encounter including on non-face-to-face activities such as preparing to see the patient or documenting in the EHR.

The high-level changes include:

  • Updates to both MDM and Total Time requirements
  • Removal of 99201
  • The history and exam are no longer part of the code selection requirement, and should still be performed and documented when medically appropriate
  • Addition of new prolonged codes when Total Time exceeds level 5

Once implemented and adopted, these changes have the potential to significantly reduce the administrative burden for clinicians and physicians, as well as help them realign their focus on patients and what’s needed for quality care.

Education is critical to helping them prepare for this change. Your physicians, other qualified health professionals, professional coders, clinic leadership, and clinic staff will all need proper training to successfully adopt these changes so your organization can start to receive appropriate reimbursement based on the updates to the MDM table or Total Time.

Outlined below are ways in which you can deploy a targeted training approach to help your team navigate these changes.

Targeted training approach

If you haven’t already, you should begin preparing as soon as possible to develop a comprehensive training approach that incorporates education on the E/M changes, as well as the clinical, operational, and technology updates that may be implemented. An effective approach should:

  • Engage key leaders to define your training plan
    Your organization should bring together an executive steering committee of key stakeholders from compliance, information technology, revenue cycle – including coding and billing – select physician practice directors, and physician super-users. At minimum a training approach, timeline, and ownership of key tasks should be defined at the work group with subsequent follow-up meetings to monitor progress and barriers.
  • Outline the targeted deployment plan
    Clearly define who will be impacted by the E/M transition in order to set a targeted training deployment plan. Here are a few recommendations for this plan:
    • Identify the training audience: Training should be prioritized based on impacted teams, which include physicians and other QHPs, professional coders, clinic leadership, clinic support staff, and any additional key stakeholders within the outpatient/office visit settings.
    • Compile the training curriculum: Training should be focused on supporting your organization through the transition in order to drive changes in behavior and processes to meet the regulation and align appropriate reimbursement.
    • Set the training medium: Understand the medium to deploy the training that suits the targeted audience – whether in a virtual, e-learning, or an in-person setting. Based on our experience, many of our client partners have had success implementing a hybrid approach with both virtual and e-learning sessions. The virtual sessions allow the audience to further engage in the changes through dedicated time for Q&A and interactive discussion. For example, they can have real-time discussions on documentation templates or the use of the LOS calculator to support this change.

      Whereas, the e-learning sessions can fit into a clinician’s schedule at their convenience. Attendees can complete each module based on their schedule and review the supporting documentation and training materials at their own pace. (E-learning pro tip: Don’t forget to catalog frequently asked questions (FAQ), so you can provide standard answers to the audience in a centralized document for ongoing reference.)
  • Establish accountability
    As part of any training deployment, it is crucial to establish accountability of attendance and comprehension. Attendance should be recorded to validate that all stakeholders have been trained. We also recommend that all attendees complete a skills assessment to confirm understanding of key concepts. The skills assessment will also enable the trainer to identify additional training opportunities, helping reinforce key concepts by developing and providing supplemental training documents – via a FAQ, coding cheat sheets, and/or a supporting standard operating procedure.

A training approach and supporting materials are key to meeting the needs of your team and achieving positive results (i.e., adoption).

How Nordic can help

If you have any questions on your training plan, approach, or materials for the E/M transition, please let us know. We’d be happy to meet with you to listen to your needs and discuss a plan that works best for your organization. Also, if we’ve piqued your interest with e-learning, check out our recently launched 2021 E/M E-Learning Modules. The training includes three modules, totaling less than 30 minutes, focused on the E/M changes including the documentation and coding updates, provider documentation recommendations and scenarios. We have also worked with organizations to customize content per specialty and add organization specific guidance to the e-learning.

And last, if you need help preparing for the E/M coding transition, aside from training and e-learning support, here are a few other considerations we can guide you through:

  • Developing supporting financial modeling to help your organization understand E/M utilization, reimbursement, and RVU impacts, such as those related to physician compensation,
  • Conducting account audits to evaluate coding and provide recommendations on opportunities to improve as physicians and coders begin to apply these new rules,
  • Evaluating further physician efficiency opportunities across workflow, documentation, and coding.

No matter your E/M training transition needs, we’re here to help!


This material is provided for information purposes only and should not be relied upon as legal, financial or tax advice. Nordic does not represent or warrant that the information provided will be complete or accurate. 

Topics: featured, Performance Improvement, Advisory Services

Module heading text

Get the highest quality chemistry and microbiology testing services aligned closely with current good manufacturing practices (CGMP) for all types of products across all phases of development.

Subscribe to receive blog updates