J. Paul Spencer, CPC, COC

This auditing and compliance “Tip of the Week” was originally published by the National Alliance for Medical Auditing Specialists (NAMAS), a division of DoctorsManagement.

If you are receiving today’s e-mail blast, chances are you are a NAMAS member in good standing, and for that our entire staff thanks you. As the countdown begins to January 1, 2021, the date on which the biggest changes to outpatient Evaluation and Management (E/M) codes in a generation will come to your doorstep, we will be relying on our collaboration with our members to find the best way forward.

Don’t forget that NAMAS and our membership are not the only resources you can depend on as 2021 approaches. The American Medical Association, who are the gatekeepers of CPT, has been publishing guidance on the E/M changes to their Ed Hub. While this continuing education portal is designed for physicians and care teams, the information it contains is a solid supplement to previously published guidance and is useful for auditors.

As auditors, the hardest part of our job going forward will be in shaping documentation of assessments and plans that truly represent the level of service being reported. Stop and think for a moment about the reverse engineering suddenly required, particularly as it applies to electronic medical record templates, and you will realize that merely explaining the new guidelines to physicians will probably be the least of the physicians’ worries.

This is the clinical breach that the AMA Ed Hub is stepping in to fill. On November 17, the AMA released an education module entitled “Changes to Reporting Evaluation and Management Office Visits: How to Prepare for 2021.” As with all modules on the AMA website, a sign-in is required, but the information contained in this module, which was taken from a recent meeting of the AMA House of Delegates, is very valuable to auditors, even though it focuses on changes that must be made in the physician


The original E/M Documentation Guidelines will soon be turning 25 years old. As a coder and auditor for most of that time frame, such a significant change to so longstanding a set of rules will carry both good and bad ramifications for me and my career as an auditor. As professionals dedicated to supporting the science of medicine by relieving administrative headaches, we must approach this sea change to outpatient E/M coding by understanding its effects on all the stakeholders. NAMAS is here to help, but don’t forget that help in the form of reliable information from reputable sources is all around us, and these extra sources will certainly be welcome as we embrace a new era of E/M coding.

This Week’s Audit Tip Written By:

J. Paul Spencer, CPC, COC
Paul is a Senior Compliance Consultant with our parent organization, DoctorsManagement. He has over 25 years’ experience on the administrative side of healthcare, including six years with health insurance carriers. In his past role as Compliance Consultant, Paul has focused on physician education, with an emphasis on documentation improvement for Evaluation & Management and surgical services.

What to do next…

  1. Contact us to discuss your audit needs by calling (800) 635-4040 or email [email protected].
  2. Read more: What can you expect from a coding and compliance review?
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