The American Medical Association (AMA) released "technical corrections" for the new 2021 Evaluation and Management (E/M) services changes that went into effect Jan. 1, 2021 to address confusion over how tests were counted under the data element portion of the E/M level in the medical decision-making table. The AMA additionally clarified guidance on the risk category.

The AMA provided clarification and revised medical decision-making on the following:

• When reporting a test that is considered, but not selected after shared decision-making
• The definition of "analyzed" for reporting tests in the data column
• The definition of a "unique" test
• What is meant by "discussion" between physicians, and other qualified health care professionals and patients
• Which activities are not counted when reporting time as a key criterion for code level selection

The AMA additionally provided significant guidance on the definition of major vs. minor surgery as determined by the medical decision-making table. In the updates, the AMA stated that risk assessment is determined by the provider, and to not use global days to determine if a procedure is major or minor (for example: if a provider is using global days to determine the risk of a procedure, then many of the percutaneous valve procedures would be accessed as minor procedures, and risk assessment would be incorrect).

Additional samples of updates regarding surgery from the AMA are below:

• Surgery – Minor or Major: The classification of surgery into minor or major is based on the common meaning of such terms when used by trained clinicians, similar to the use of the term "risk." These terms are not defined by a surgical package classification.

• Surgery – Elective or Emergency: Elective procedures and emergent or urgent procedures describe the timing of a procedure when the timing is related to the patient's condition. An elective procedure is typically planned in advance (e.g., scheduled for weeks later), while an emergent procedure is typically performed immediately or with minimal delay to allow for patient stabilization. Both elective and emergent procedures may be minor or major procedures.

• Surgery – Risk Factors, Patient or Procedure: Risk factors are those that are relevant to the patient and procedure. Evidence-based risk calculators may be used, but are not required, in assessing patient and procedure risk.

These updates became effective March 9, 2021. Read them here. For additional details regarding the updates, visit the AMA website.

Keywords: ACC Advocacy, Minor Surgical Procedures, American Medical Association, Decision Making, Elective Surgical Procedures, Risk Assessment

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