New legislation, as well as changes in patient expectations, present a host of challenges and opportunities for getting paid for service this year. In a recent article in Physician’s Practice, we discussed the challenges surrounding getting paid for telehealth this year and beyond . This is an essential issue for independent practices, but it’s not the only one. New legislation, as well as changes in patient expectations, present a host of challenges and opportunities for getting paid for service this year. E/M Office and Outpatient Guidelines Changes For the first time in more than two decades, the AMA has revised the guidelines for office and outpatient visit evaluation and management (E/M) codes. It’s been a long time coming—effective this year, CMS has aligned E/M coding with the changes adopted by the AMA. For many providers, this means an increase in their revenue because they will finally be compensated for time spent in activities related to patient care that were previously

A new code for COVID-19 discharges offers a 20% bump in the assigned MS-DRG payment from CMS. Clinicians should know that a positive test result is not required to establish a COVID-19 diagnosis for coding purposes. If a patient admitted with a respiratory diagnosis then tests positive for COVID-19, coders can link the result to the respiratory illness. With new legislation such as the Coronavirus Aid, Relief and Economic Security (CARES) Act supplying grants to help stabilize hospitals and health systems, documentation and coding become increasingly vital for providers to capture the available funding. An unprecedented off-cycle adoption of code U07.1, COVID-19 , effective with discharges on and after April 1, 2020, was announced by the Centers for Disease Control and Prevention in mid-March.  As provided in the ICD-10-CM Official Guidelines for Coding and Reporting, the coding guidance for COVID-19 has unique features that all coding professionals and clinical documentation special