It can be difficult to translate the E/M rules into patient scenarios that ring true and are applicable to every day clinical encounters. The guidelines seem great in theory, but how does a clinician, coder, or auditor apply them to select the correct level of service? Here are examples based on MDM, not time, that […]
Anatomy of an Audit™
Recorded February 4th, 2025
1 CEU expire 3/30/27
Guest presenters Pam D’Apuzzo and Debra Rossi of VMG Health, and Pam Warren of MaineHealth
These two sessions take a deep dive into the audit process. Session one focuses on E/M Services, and session two, Surgical Procedures & Diagnostic Tests.
FAQ: Scoring Elements in the E/M Guidelines
Scoring MDM elements can be challenging for E/M services This post includes questions related to: Major/Minor Procedure Data Elements (with link to additional resources) General Questions about the guidelines Using Time (with link to additional resources) Social Determinants of Health Major or Minor Procedure? Question: I have a question about how to determine if a […]
Multiple E/M Services in the Same Calendar Day
The AMA added a new subsection in the 2024 E/M section addressing how to report E/M services when there are multiple encounters in the same day. (Pages 6 and 7) According to CPT® Changes 2024 An Insider’s View, the reason for this was to provide clarification for when multiple E/M services were performed on the […]
E/M Services: High Volume, High Risk | Webinar
Recorded October 19, 2023
According to CMS, E/M services comprise 40% of allowed charges in the physician fee schedule, 20% office visits and 20% other E/M services. Medicare’s expense is medical practice revenue, with the income from some primary care practices comprising 70% or more of total charges. To protect the organization, compliance professionals can focus on four components of E/M.
2023 E/M Guidelines for Hospital, Nursing Facility, Home and Residence Services | Webinar
Recorded September 22, 2022
As expected, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. They extended the documentation framework in place for office visits to these codes. They also deleted twenty-five codes. Coding for prolonged care services gets…
Coding Guide – E/M Services
This coding guide describes the guidelines for evaluation and management (E/M) services reported in the office or outpatient department, consultations, ED visits, inpatient and observation hospital visits, nursing facility and home services. There are specific changes related to these categories of codes described here. The guide will also discuss how to select the level of service based on either time or medical decision-making.