E/M Coding For Physicians & Hospitals And Auditing E/M Coding Compliance
*This program has the prior approval of AAPC for 1.5 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.
Understanding “new technology” ICD-10-PCS codes are critical to hospital revenue. Changes are effective October beginning.
Review the Evaluation and Management E/M codes as they appear in the CPT Manual, and explore guidelines used by physicians and hospitals including the new approach for CY2021.
E/M coding for physicians was introduced along with the MPFS starting back in 1992. E/M coding for hospital outpatient services started with the implementation of APCs in 2000. Physicians code for what they do using mainly the history, examination and medical decision making as guides. There is guidance for physicians in the CPT Manual as well as separate guidelines from CMS. Hospital E/M coding is based on resources used and is thus quite different. CMS was supposed to develop guidelines, but for 2014 CMS made the surprising move to institute a single HCPCS code, namely G0463, for the ten clinic level visits. This move was a major mistake now that we have Section 603 clinics from BiBA 2015 by which off-campus provider-based clinics at to be paid at the freestanding clinic rate.
New guidance for E/M levels has been developed and implemented by CMS whereby E/M levels are determined by either medical decision making or time. Further changes are anticipated in 2021 based upon AMA recommendations which have been adopted by CMS for the Medicare program. A brief discussion of consultation codes for telehealth is included along with transparent pricing issues as mandated for hospitals. Documentation concerns and compliance challenges relative to auditing E/M coding discussed for both physicians and hospitals. The use and misuse of the “-25” modifier along with other modifiers surrounding E/M coding the global surgical package.
Expert presenter, Duane C. Abbey, CFP, in 90 minutes webinar, will also cover the Audit techniques that are outlined relative to assuring proper compliance with E/M coding, while working through practical Cases.
- Understand How Physicians and Hospitals Use E/M Codes and review Associated Documentation
- Understand the Changes to E/M Coding Criteria Relative To Decision Making and Time
- Learn About the CMS Facility E/M Coding Principles and the G0463
- Understand the Difficulties with E/M Coding for the ED
- Appreciate How To Adjust to CMS Dropping the Consultation Codes
- Review Special Situations for E/M coding for Telehealth and Transparent Pricing for Hospitals & Physicians
- Appreciate Documentation System Including ‘Copy and Paste’ Capabilities
- Understand the Interplay Between Facility component E/M Coding and Physician E/M Coding
- Learn About the Difference Between a ‘New’ Patient versus an ‘Established’ Patient
- Learn About Changes in Office Visit for Medicare for CY2019-CY2021
- To review the E/M codes as they appear in the CPT Manual.
- To understand the use of G0463 and BBA 2015 Section 603 clinics.
- To establishing an E/M coding audit program, and how to organize an E/M Coding Audit for Either Physicians or Hospitals.
- To appreciate the difference between ‘new’ versus ‘established’ patients for physicians and hospitals.
- To appreciate physician coding for incident-to billing.
- To understand the differences in E/M coding for ER physicians and provider-based clinic physicians both primary care and specialty.
- To explore the compliance challenges faced by both physicians and hospitals for E/M coding and the “-25” modifier.
- Recognize how to make changes to accommodate CMS’s dropping the use of the consultation codes.
- To explore how EHR systems create challenges for developing proper documentation to support E/M coding.
- To review changes that are being made for office visit E/M codes for Medicare
- E/M Coding Guidelines
- E/M Coding Under RBRVS, Under APCs, and General Categories
- Physician Guidelines, Physician Use of E/M Codes
- Hospital Developed Guidelines: G0463, and BBA 2015 Section 603 Clinics
- Variations for ED and Provider-Based Clinics
- New Guidelines for CY2019-CY2021
- Consultation Code Issues and the “-AI” Modifier
- Electronic Health Record Systems EHRs
- Update to Office Visit Codes for Medicare
- CMS Proposal for Special G-Codes
- Changes in Documentation Guidelines
- Planning An E/M Coding Audit
- Overall Objective, Number of Cases For Selection
- Stratification of E/M Levels
- Use of OIG’s RAT-STATS Program
- Audit Guidelines
- Assessing Impact of Electronic Health Record Computer Systems
- Report Writing and Developing Recommendations
- CMS Coding System Principles and Guidance, CMS Audit Criteria, and CMS expectations
- Sources for Further Information
Who Should Attend
- Clinic Managers, and Clinic Administrators
- Coding Personnel, Compliance Personnel
- Billing and Claims Transaction Personnel
- Nursing Staff, Clinical Service Area Personnel
- Chargemaster Coordinators
- Financial Analysts
- Physicians, Non-Physician Practitioners, Healthcare Auditors and Other Interested Personnel
Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.
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