EVALUATION AND MANAGEMENT CPT CODING-2017

EVALUATION AND MANAGEMENT CPT CODING GUIDELINES BY BHARATH KUMAR MEDESUN STUDENT

1. TOPIC ON E/M(EVALUATION AND MANAGEMENT

2. It covers patient disease, history, exam, and MDM(medical decision making). 80% of cpt codes covers E/M services. Assign E/M code whenever there is a documentation of history examination and MDM. E/M code covers 10k-6k series with respective modifiers INTRODUCTION

3. Based upon place of service(office visits,hospital visits,consultations ) Based upon age Time taken for assessment Office visits again subdivided as new patient(or) established patient Hospital visits again sub divided as initial(or) subsequent patient. CLASSIFICATION OF E/M SERVICES

4. If time dominates a visit(taking too much time in assessing a patient) assign separate code with respect to time. Classification is very important because nature of work varies based on type of service place of service and patient condition.

5. 7 major components History Examination MDM(medical decision making) Time Counseling Co-ordination of care NPP(nature of presenting problem) COMPONENTS OF E/M SERVICES

6. First 3- components are key components Rest of 4- components are contributory components. LEVELS OF E/M SERVICE:- it designed as Giving unique code number Mentioning place/type of service provided Content of the service Finding present problem Time taken for MDM decision.

7. New patient visit requires more time than established patient More resources are required for new patient For new patient Payment may be 40% higher than established patient Separate codes are available for new and established patients Patient come back within 3 years of time considered as established patient NEW/ESTABLISHED PATIENT

8. 3 years is the considering factor Absence of specification assume it as established patient HOW TO ASSIGN E/M CODE? Analyze the patient(new/established) Place of service Age Time Key components

9. 8- elements are listed they are Location Duration Severity Quality Associated signs&symptoms Time Modifying factors context ELEMENTS OF HPI(history of present illness)

10. If 3- elements are documented, (HPI is brief) Example: abdominal pain since morning due to spicy food If more than 3- elements documented,(HPI is expanded). Example :edema of both legs due to ckd with diabetic foot since 4 months and k/c/of diabetic&hypertension since 5 years.

11. Payment difference for every element is 10 dollars. Pay&chase model:- insurance company pay first later on chase. Self-disclosure scheme:- under this scheme physician can declare self errors and publish there by refunds the money to insurance companies

12. It is a questionnaire where patient has to respond There are 11- ros are there:- EYE ENT Cardiovascular Respiratory gastrointestinal REVIEW OF SYSTEMS(ROS)

13. Genitourinary Musculoskeletal Integumentary neurological neurologic Psychiatric Hematologic/lymphatic

14. Physical exam is objective evidence ROS is subjective evidence NATURE OF PRESENTING PROBLEMS They are 5-types Minimal Self-limited Low severity Moderate severity High severity

15. HISTORY EXAMINATION MDM(LEVEL) PROBLEM FOCUSED PROBLEM FOCUSED STRAIGHT FORWARD EXPANDED EXPANDED LOW LEVEL COMPLEXCITY DETAILED DETAILED MODERATE LEVEL COMPLEXICITY COMPREHENSIVE COMPREHENSIVE COMPREHENSIVE Classification of history,examinantion,MDM .

16. Physical exam is done by four ways Inspection(seeing) Palpation(touching) Auscultation(hearing) Percusion (tapping)

17. There are 2- types of guidelines for E/M coding 1995-guidelines 1997-guidelines Cpt book has 1995-guidelines Auditors preffers 1997-guidelines 1995-guidelines based on history and MDM 1997-guidelines based on bullet points

18. If there is no specific mention code as established patient Considering three key factors(history/exam/MDM) If a level is not matching, as per CPT guidelines drop the level SELECTION OF E/M SERVICE CODING

19. For new patient 3/3 levels should be match For established patient2/3 levels is minimum Dollar value depends on physician+practice+malpractice insurance.

20. Time is a considering factor for E/m services It includes both new/established patients Minimum 8- hours are required for discharging a patient on same day Day-1 considered as initial hospital care Dy-2 is subsequent day Discharge is based on time. HOSPITAL OBSERVATIONAL SERVICES

21. It is a type of service, in this service one physician can refer another physician for a specific condition Consultant physician can start diagnosing the patient or therapeutic services subsequently. Such services are reported under office visit,home service,etc …. Written format for consult physician may made by a physician are documented in patient medical records.. CONSULTATIONS

22. This code are given only when treatment or services done in emergency department. Case must be seen by emergency physician Emergency department must be 24/7 New/established patients included. Critical care services provide in ED reported separately EMERGENCY SERVICES

23. Time is not a discriptive factor in ED ED service coding given based upon intensity. It may involves multiple encounters So time is not a considering factor

24. Critical care is given by direct physician or any other health care professionals Monitoring vital signs are very important It requires high complexity decision It depends on total duration of time If less than 30- minutes use appropriate E/M services. CRITICAL CARE

25. Critical care provided to 29 days to 71 months code from pediatric critical care. Critical care is provided with other E/M services code separately Range of code 99291-99292.

26. Nursing facility service codes given when E/M services are at skilled nursing facilities. This codes also used for psychiatric residential treatment center. If any other services are along with this code separately. NURSING FACILITY SERVICES

27. Prolonged services without direct patient codes are 99358-99359. Preventive medicine services are include infants,children , and adults Range of code for new patient 99381-99387 Range of code for established patient 99391-99397 Telephonic services are not face-to- face services

28. Telephonic services are given through telephone Range of code 99441-99443 On line medical evaluation is by physician to patient through internet sources Range of code 99444 https://www.medesunglobal.com/

29. THANK YOU