Early Changes in Billing and Notes After Evaluation and Management Guideline Change

Area of Science:

• Health Services Research
• Medical Informatics
• Healthcare Policy

Background:

• The American Medical Association (AMA) revised outpatient evaluation and management (E/M) billing codes in 2021.
• The revisions aimed to incorporate non-face-to-face provider time and decrease documentation burdens.

Purpose of the Study:

• To assess changes in E/M visit utilization, documentation length, and electronic health record (EHR) time post-AMA guideline update.
• To analyze the impact of new E/M coding guidelines on provider practices.

Main Methods:

• An observational, retrospective, pre-post study design was employed.
• Data from 303,547 providers across 389 U.S. ambulatory practices using Epic Systems EHR were analyzed.
• Provider-level E/M code usage, note length, and EHR time metadata were extracted and compared before and after the guideline change.

Main Results:

• A significant decrease in Level 3 E/M visits and increases in Level 4 and Level 5 visits were observed.
• These coding pattern shifts varied by medical specialty.
• No significant changes were detected in note length or total time spent within the EHR.

Conclusions:

• The updated E/M guidelines rapidly influenced coding practices but did not immediately alter EHR documentation time or length.
• Healthcare organizations adapt more quickly to billing changes than to modifications in care delivery and EHR usage.
• Achieving the full benefits of the guideline revisions necessitates further time, support, and the implementation of best practices for EHR documentation.