Product
 

Issue Identified: 2021 E/M Coding Advisor Logic

Our team has been made aware of the following issue impacting certain gGastro® clients on v. 4.72 or higher, experienced in connection with the 2021 E/M Coding Advisor. Our engineers are working to address this issue and we expect to resolve the issue with the upcoming release (v. 4.72.1.5), anticipated to be released at the end of January, 2021. In the meantime, please use the workaround provided below if you experience this issue.

Issue Description:
The suggested code calculation may not render the most appropriate code when billing by MDM if each element of MDM is a different level (i.e., one at “low”, one at “medium” and one at “high”). For example: for an existing patient that has a “high” number of problems, “moderate” complexity of data and “low” risk, in some instances, 99213 would be a more appropriate code than 99212, as the system is generating currently.

This issue is occurring because, in order for the MDM logic to qualify for a particular level of medical decision making, two out of the three elements for that level of MDM must be met or exceeded. Because this requirement is not met if each of the three elements falls within a different level (i.e., no MDM level has two or more elements), the system logic is suggesting the lowest MDM level, rather than taking into account the “or exceeded” language of the requirement. As a result, the logic is suggesting a code calculation that may be lower than what would be supported by the documentation.

Sample

Issue Workaround:
Users can manually update and change the code in the Coding Advisor screen and override the suggested codes if they deem appropriate.

Impact:
Our analysis suggests that the occurrence rate of this issue in which the user does not correct the miscalculation in the user interface averages
< 2% of qualifying office visits. ​​​​We will follow up in the next few days with information on the availability of 4.72.1.5 and how to obtain a list of visits that may have been impacted. We apologize for any confusion or inconvenience the above issues have caused you and your practice.

 

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