Evaluation and Management Coding. E/M Coding. E/M-Initial Visit. Tony Poggio, DPM

Transcription

1 Evaluation and Management Coding Tony Poggio, DPM E/M Coding May use 1995 or 1997 requirements Selection based upon documentation and actual level of care rendered NOT simply diagnosis Proper use of modifiers E/M-Initial Visit Must meet criteria for all three components History Examination Decision Making Must be medically necessary and reasonable Must be pertinent to the condition you are treating use if patient not seen in three years

2 E/M- Follow-up Visit 2 of 3 components must be met for specific level of service History Examination Decision Making Time Must be medically necessary and reasonable Must be pertinent E/M History Problem Focused (2 of 3) History Chief Complaint History of Present Illness Review of Systems Past Family/Social History E/M Examination Expanded Problem Focused Exam (6 bullets) Vitals (3 measurements), appearance Vascular (circulation, lymphatic) Skin Neurologic (DTR, sensation, coordination) Musculoskeletal (ROM, joint stability, strength, mal-alignment, tenderness

3 E/M Decision Making of Low Complexity Number of diagnosis Acute injury Underlying chronic conditions Requesting diagnostic testing Implementing therapy Prescribing medication Decision for procedure E/M CPT examples 80 y.o female to evaluate medical management of arthritis 3 y.o. earache and dyshidrosis of feet pigment superficial nodule on leg symptomatic 58y.o female with painful unilateral bunion E/M CPT examples 45 yo female with osteoarthritis and painful swollen joint Psoriasis involvement of elbows, pitting of nails and itchy scalp

4 E/MvsConsult Are you being asked for an opinion Are you taking over care of the patient referral from a doctor vs patient Consultation report Multiple E/M services Can only bill for one E/M service within 24 hour period regardless of place of service. Select the one with the higher RVS units to reflect the work performed E/M: Nursing Facility Use for SNF, ICF, LTCF May need referral/request from MD or family PRN orders may not suffice Select code level that reflects service provided Must include review of medical record in addition to examination and decision making

5 E/M: Nursing Facility Do Not use 9930X series: New or established comprehensive assessment Use code series 9931X- New or established subsequent nursing facility care Use correct Place of Service If new patient add -25 modifier E/M: Home Services Use Office Visit E/M guidelines 3/3 components for initial visit 2/3 components for follow-up visit Patient must be homebound Can not use E/M to continually certify need for routine foot care Care Plan Oversight Only one physician can bill per month Physician responsible for care of patient Must be for at least 15 minutes/month

6 LOPS Can only use for diabetic patient with neuropathy G0245/46 If not seen by foot care specialist within 6 months E/M : Modifier -24 Unrelated Evaluation and Management service by same physician during a post-operative period Example: E/M of an ankle sprain during global period of a bunionectomy May be the same ICD-9 code E/M: modifier -25 Significant, separately identifiable evaluation and Management service by the same provider on the same day of a procedure

7 E/M: Modifier -25 Use with initial OV or nursing facility service if service pertains to covered RFC Use for presentation of a new problem for an established patient if a minor procedure (0 or 10 day global) performed on the same day may be the same ICD-9 code E/M: Modifier -25 Do not use E/M +modifier once diagnosis is established. update H&P for established problem included in fee allowance for the procedure E/M: Modifier -57 Decision for Surgery Evaluation and management service that resulted in decision to perform major surgery (90 day global period) within 24 hours