HCPCS Code Change Transforms Landscape of Preventative Care

Ashish Patel

December 6, 2021

Until now, healthcare providers spent up to 40% of their time on administrative tasks, largely due to the complexity of the code system. Spending more time on paperwork meant spending less time with patients which was frustrating for everyone.

Recently, the AMA revised the definitions for Evaluation and Management (E/M) codes in the Current Procedural Terminology (CPT) 2021 codebook. The primary goal of this revision was to simplify coding and documentation of office visits, which largely affects Primary Care Physicians (PCP’s). This change in coding structure offers healthcare providers more time to review patient charts and consult with specialists.

Primary care governs the trajectory of patient care and a patient’s experience. It determines which patients are referred to specialists and which patients require advanced treatments. You can think of PCP’s like the quarterback and head coach of patient care. With so much direction and management in their hands, it makes sense to allow them to spend more time on their jobs, and less time on cumbersome paperwork.

This new coding structure allows physicians the opportunity to focus on medical decision-making (MDM), or code based on total time. PCP’s are now free to document their thought processes instead of spending time making their history and exam factor into specific codes.

Another benefit of this change is that it increases coding accuracy which leads to an improvement in the data collected to support analytics and research.

For example, with Careset’s ability to identify procedure and diagnosis codes, we’re able to pinpoint providers who manage a variety of different conditions, medications, and the clinical complexity of their caseload. Our data also reveals which providers manage good adherence to medical treatments which helps to identify where value-based arrangements lie.

The 2021 changes to E/M coding will result in CMS paying more for some codes going forward. However, additional reimbursement to PCP’s may result in larger savings down the road, by reducing the number of hospitalizations and advanced treatments. When PCP’s have more time to work with patients on preventative care and effective management of chronic health conditions, patient care and satisfaction will improve.

Call 713-766-5588 or visit https://careset.com/contact-us for more information

Ashish Patel

Ashish is co-founder of CareSet Systems. An entrepreneur and healthcare data transparency advocate, Ashish also founded the DocGraph Journal, bringing together the Healthcare Data Science community along with Politico and ProPublica to publish data sets for scientific advancement. Ashish is currently working to decode Medicare Claims data for Pharmaceutical companies, helping analyze provider teaming, and building robust networks.

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