Question: I believe that I know the answer to this question but am hoping you know the source, as I can't find it—if a nurse helps with ROS, … [Read more...]
E/M services
For many practices, E/M services are what you do the most. Knowing what type of service to bill, what level of service and the rules related to the visit will decrease denials and payment delays. Here you'll find an overview, MDM and rule changes, resources organized just like your CPT book, and a bonus section with E/M frequency data.
2023 E/M Guidelines for Hospital, Nursing Facility, Home and Residence Services | Webinar
2023 E/M guidelines for hospital, nursing facility, home and residence services Recorded September 22, 2022 As expected, the AMA has revised the … [Read more...]
Acute, Uncomplicated vs. Acute with Systemic Symptoms
Question: When using the E/M guidelines, is the problem an an acute, uncomplicated illness or an acute illness with systemic … [Read more...]
Coding Critical Care Services | Webinar
Critical Care Services Coding Update Recorded January 2023 CMS made significant changes to critical care coding effective in 2022. Not only did … [Read more...]
When to Use Time to Select an E/M Service
Selecting a code for an E/M service can be done based on time or MDM (except ED visits which only use MDM) Time includes all time spent by the … [Read more...]
Consultation Codes
First, CMS stopped recognizing consult codes in 2010. Outpatient consultations (99241—99245) and inpatient consultations (99251—99255) were still … [Read more...]
E/M Office Visit Scenarios
It can be difficult to translate theE/M rules into patient scenarios. The guidelines seem great in theory, but how does a clinician use them and … [Read more...]
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 … [Read more...]
Coding Guide – E/M Services
This coding guide will describe the guidelines for evaluation and management (E/M) services reported in the office or outpatient department, … [Read more...]
The Second Element of MDM: Amount and/or Complexity of Data
There are three elements in medical decision-making and this article describes the second, arguably, the most complex of the three elements When … [Read more...]
The Third Element of MDM: Risk of Complications
The third element of MDM: risk of complications and/or morbidity or mortality of patient management at the encounter Coding for E/M services … [Read more...]
The First Element of MDM: Number and Complexity of Problems Addressed
E/M elements for MDM There are three elements in medical decision-making and this article describes the first of three When selecting a level … [Read more...]
E/M Services – History and Exam
History and exam for E/M services “E/M Codes that have levels of services include a medically appropriate history and/or physical examination when … [Read more...]
New Versus established Patient Visits
There are other articles on CodingIntel about the difference between new and established patients, and the rules haven’t changed, but that doesn’t … [Read more...]
Transferring a Sick Baby to Another Hospital
Question: Our pediatric group practices in a community hospital, without an NICU. My pediatrician was called to attend a delivery of a newborn who … [Read more...]
Drug Therapy Requiring Intensive Monitoring for Toxicity
Question: When auditing MDM, is there a list of drugs that are considered “drug therapy requiring intensive monitoring for … [Read more...]
Initial Hospital Service Codes and Established Patients
Question: We are having a disagreement in our coding department. Our cardiologist sees an inpatient at the hospital, but it’s a patient she knows … [Read more...]
Emergency Department Visits
Definition Emergency department (ED) services are E/M services provided to patients in the Emergency Department. Explanation These services … [Read more...]
CPT® and CMS Rules for Critical Care | What’s the Difference?
CMS and CPT count critical care time differently. CMS issued a “technical correction” in the 2023 PFS Final Rule. They stated that it is their … [Read more...]
Coding Guide – Newborn and Pediatrics
Neonatologists, pediatricians and family physicians who care for newborns and sick children in the hospital need to select the category of code that … [Read more...]
Critical Care for General Surgery and Trauma Surgeons
Critical care provided as a stand alone service is based on the seriousness of the patient, the types of interventions, and time. Critical care … [Read more...]