Over the past 4 years, the American Medical Association and the Center for Medicare and Medicaid Services have implemented new guidelines for Evaluation and Management Services. The first changes involved Office and Outpatient visits, and then, 2 years later, changes were made to Evaluation and Management services for the hospital, skilled nursing facility, and other resident facilities.

As the new guidelines were being used, clarifications and revisions had to be made to assist providers in applying the guidelines as described. In this event, we will go over the guidelines and also discuss the 2025 updates to this chapter of CPT.

Attendees will not only understand the code visit changes for 2024, but they will learn firsthand the reasoning behind these changes and appropriately application for compliant, clean claims.

They will also gain enough knowledge to educate others within their office, so that all are aware.

• Look at the 2021 and 2023 guidelines for Evaluation and Management services.
• The appropriate reporting of shared/split visits.
• 2025 changes and revisions to CPT for Evaluation and Management
• New assignments for using the time.
• More Information regarding consultations
• A deeper look at prolonged services
• A job aid to see what prolonged add-on code is assigned to each section of E/M
• Utilizing time to report multiple visits in a day
• Revisions to the table of risk
• Medicare code G2211
• Telehealth after 2024
• Other changes by CMS.

Auditors are still seeing errors in the level of service being reported is not supported by the documentation. Any are not following the guidelines rules spelled out in 2021 and 2024.

In knowing and understanding the coding changes for 2025, denials and delays in claims processing by insurance companies that hold up reimbursement will be avoided, and the office cash flow will be maintained. Visits are always being scrutinized by insurance carriers, but the fact is that these services are the most expensive to the insurance companies of any service or procedure.  An audit by an insurance company, if errors are found, could cost a provider and/or practice refunds of the services and possible fines and penalties.

• Physicians
• Nurses
• Physicians assistants
• Billers
• Coders
• Surgery schedulers
• Claims adjusters
• Collection staff
• Managers.