52 results.
Using CPT Modifier -25 for Professional Billing
Author: Yoder, Lois M.
Source: Journal of AHIMA
Publication Date: January 2000
You may want to consider a focused review of how your practice assigns CPT modifier -25, "a significant, separately identifiable Evaluation & Management (E&M) service by the same physician on the same day of the procedure or other service."1 The Health Care Financing Admini....
Understanding The History Component of The E/M Code - Part 2
Author: Maccariella-Hafey, Patricia C
Source: CodeWrite | AHIMA newsletter article
Publication Date: January 2015
This is the second of a two-part series on the history component of the CPT Evaluation and Management code. The first part was published in the December 2014 issue of CodeWrite.
Levels of Evaluation and Management (E/M) services are based on four types of history (Problem F....
Understanding the History Component of the E/M Code (Part 1)
Author: Maccariella-Hafey, Patricia C
Source: CodeWrite | AHIMA newsletter article
Publication Date: December 2014
This is the first of a two-part series on the history component of the CPT Evaluation and Management code.
As discussed in the October 2014 CodeWrite article "Introduction to Evaluation and Management Services," evaluation and management (E/M) services are cognitive services....
Teaching Physician Guidelines
Author: Graff, Jean Stevens
Source: Brief Encounter
Publication Date: September 02, 2001
Working in an orthopedic clinic, I understand the great need for my newly created position. I am employed at a teaching hospital as a medical record auditor charged with the task of educating physicians on the art of coding and documentation. My job is to ensure compliance with the Medicare ma....
Solving the E/M Conundrum: a Special Report
Author: Scichilone, Rita A
Source: Journal of AHIMA
Publication Date: July 2001
Evaluation and Management (E/M) codes, introduced in 1992 for reporting physician visit services, are linked to a number of perplexing questions for coders. In different settings, they are used differently and with varying sets of criteria. Given the numerous coding and compliance issues relate....
Review of E/M Guidelines
Author:
Source: Brief Encounter
Publication Date: July 02, 2001
The Evaluation and Management guidelines are found in the Medicare Carriers Manual in the following sections. You may download the entire manual from the Center for Medicare and Medicaid Services or CMS (formerly HCFA) Web site by going to http://www.hcfa.gov/, click on Medicare, select laws an....
Recommendation for Standardized Hospital Evaluation and Management Coding of Emergency Department and Clinic Services
Author: American Hospital Association; AHIMA
Source: AHIMA
Publication Date: June 24, 2003
Produced by the Hospital Evaluation and Management Coding Panel of the American Hospital Association and American Health Information Management Association
June 24, 2003
EXECUTIVE SUMMARY
Background
Since the inception of the Medicare hospital outpatient prospective....
Principles for Emergency Department Coding Guidelines
Author: Lojewski, Tedi
Source: Journal of AHIMA - Coding Notes
Publication Date: September 2008
Since the implementation of the Outpatient Prospective Payment System (OPPS), the Centers for Medicare and Medicaid Services (CMS) has required hospitals to report facility resources for emergency department (ED) visits using CPT evaluation and management (E/M) codes.
However, CMS re....
Outpatient Prospective Payment Becomes A Reality
Author: Scichilone, Rita A
Source: Journal of AHIMA - Coding Notes
Publication Date: June 2000
Do you know your APCs? July 1, 2000, is the start date for the Ambulatory Payment Classification (APC) prospective payment system for Medicare reimbursement. CPT coding skills will directly affect revenue as the current Ambulatory Surgery Center (ASC) methodology is abandoned and mor....
Observation Services Present Compliance Challenges
Author: Prophet-Bowman, Sue
Source: Journal of AHIMA
Publication Date: March 2003
Observation services have been a top fraud and abuse target of the Office of Inspector General (OIG) of the Department of Health and Human Services, primarily due to the complexity of the Medicare billing regulations and the potential for abuse. New regulations regarding reimbursement for thes....
Next Generation of E/M Guidelines
Author: Hill, Emily
Source: Journal of AHIMA - Coding Notes
Publication Date: November 2000
Few non-clinical issues have inspired as much discussion, revision, and anxiety as the evaluation and management (E/M) services and their accompanying documentation guidelines. E/M services have produced a cottage industry focused on ensuring that medical records contain necessary docu....
Navigating the Physician Services Maze
Author: Skurka, Margaret A.
Source: Journal of AHIMA
Publication Date: July 2001
As HIM professionals know, accurate and complete documentation is critical for providing care and supporting reimbursement. This is particularly true-and yet particularly problematic-in the area of E/M coding. Medical practices report and are paid for their services using E/M coding, yet there....
Modifier 25 — Defending a "Significant, Separately Identifiable Service"
Author: Morrow, Karna W
Source: CodeWrite | AHIMA newsletter article
Publication Date: September 2016
Think about the last time you attached modifier 25 to an Evaluation and Management (E/M) code. What were the circumstances? It was a new patient. The procedure or service was not planned. The provider documented each of the key components in addition to documenting the procedure. The payor....
Modifers – ‘Friend or Foe’
Author: Swindle, Jennifer
Source: AHIMA Convention
Publication Date: October 02, 2011
ABSTRACT:
Background: The need for modifiers to further and appropriate identify accurate coding information to all payers is critical for appropriate and accurate reimbursement. Failure to use modifiers can have a negative impact on a physician or an organizations’ revenue as witho....
Key Issues in the 2009 OPPS Final Rule
Author: Clark, Andrea
Source: Journal of AHIMA - Coding Notes
Publication Date: March 2009
The final rule for the 2009 Outpatient Prospective Payment System (OPPS) includes multiple revisions that hospitals must address in their practices, policies, and operations. Hospitals should develop strategies for analyzing the financial impact and operational challenges by reviewing the foll....
Introduction to Evaluation and Management Services
Author: Huey, Kim
Source: CodeWrite | AHIMA newsletter article
Publication Date: October 2014
Evaluation and management (E/M) are cognitive services in which a physician or other qualified healthcare professional diagnoses and treats illness or injury. Almost all specialties will perform evaluation and management services. Even physicians who generate the bulk of their revenue in....
HCFA Guidelines on Consultations
Author:
Source: Brief Encounter
Publication Date: April 02, 2001
reprinted from Medicare Intermediary Manual
FY 2016 CPT Updates
Author: Clack, Crystal
Source: Journal of AHIMA - Coding Notes | Journal of AHIMA
Publication Date: February 2016
When the first edition of the Current Procedural Terminology (CPT) was released in 1966, there were only 3,554 codes. In 2016, CPT, published by the American Medical Association (AMA), is celebrating its 50th birthday with 10,000 CPT codes. This year’s CPT updates include 140 codes added,....
Focused Physician Coding Audits: Using Modifier 25
Author: Stanfill, Mary H
Source: Journal of AHIMA - Coding Notes
Publication Date: February 2004
The physician section of the 2004 OIG work plan includes a focus on appropriate use of modifiers used to bypass National Correct Coding Initiative edits and modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedur....
Evaluation & Management Services Guide
Author: Medicare Learning Network
Source: Government (U.S.)
Publication Date: July 02, 2007
Evaluation & Management Services Guide
Author: Medicare Learning Network
Source: Government (U.S.)
Publication Date: June 02, 2008
Evaluation and Management Documentation and Coding Technology Adoption
Author: Fenton, Susan H.; Gamm, Larry D.
Source: AHIMA Computer-Assisted Coding Meeting
Publication Date: October 05, 2007
Evaluation and Management Documentation and Coding: Results from an Exploratory Study
Author: Fenton, Susan H.; Gamm, Larry D.
Source: AHIMA Foundation | AHIMA eContent
Publication Date: May 02, 2007
E/M Options in the Outpatient Arena
Author: Jones, Lolita M.
Source: Journal of AHIMA
Publication Date: July 2001
Under the Medicare ambulatory payment classification (APC) system, hospitals must establish criteria for mapping the medical care rendered in the emergency department and hospital-based outpatient settings to appropriate CPT medical visit codes. Do you know how to establish a sound rationale f....
E/M Coding Problems Plague Physicians, Coders
Author: King, Mitchell S.; Lipsky, Martin S; Sharp, Lisa
Source: Journal of AHIMA
Publication Date: July 2002
As the government turns its high beams on fraudulent billing, physician E/M coding is raising questions. With several studies spotlighting the difficulty physicians have in applying CPT E/M codes, the authors wanted to know if credentialed coders had the same problem. Here’s what they fou....
E/M Coding: Hospital Clinic Model
Author: American Hospital Association; AHIMA
Source: AHIMA
Publication Date: June 24, 2003
E/M Coding for Nonphysician Practitioner Services
Author: Cox, William G.
Source: Journal of AHIMA - Coding Notes
Publication Date: June 2004
Effective January 1, 1988, a provision of the Balanced Budget Act of 1977 (Section 4511) removed restrictions on settings where nurse practitioners, physician assistants, and clinical nurse specialists provide services. The definition of a clinical nurse specialist was also modified to requir....
E/M Coding: Emergency Department Model
Author: American Hospital Association; AHIMA
Source: AHIMA
Publication Date: June 24, 2003
E/M Coding: Critical Care Model
Author: American Hospital Association; AHIMA
Source: AHIMA
Publication Date: June 24, 2003
E/M Auditing: Establishing an Effective Audit Program
Author: Boppre, Debra
Source: AHIMA online training
Publication Date: April 07, 2011
Seminar Date: April 7, 2011
Faculty: Debra Boppre, RHIA, CCS, CCS-P
Description
E/M Auditing: Establishing an Effective Audit Program focuses on developing the required skills to accurately validate physician practice E/M services from a compliance perspective. This....
Do You Want Fries With That? Decoding All the 'Extras' in Physician Visits
Author: Davies, Sharon
Source: Journal of AHIMA - Coding Notes | Journal of AHIMA
Publication Date: September 2016
Place an order at almost any fast food chain and you can expect to hear the cashier ask, “Do you want fries with that?” From fries to soft drinks to apple pie desserts, extras abound at any given restaurant. When working on the coding for physician visits, it’s important to keep all the p....
Don’t Let Preventable CPT Coding Mistakes Cause Heartburn
Author: Clack, Crystal
Source: Journal of AHIMA - Coding Notes | Journal of AHIMA
Publication Date: November 2015
Every medical practice should have preventive measures in place to avoid costly coding and billing audits, errors, and subsequent delays in payment. Incorrectly coded claims, missing charges on a patient encounter, and other mistakes can take a substantial bite out of both practice and ph....
Don't Let Gastroesophageal Coding Cause Heartburn: Using GERD to Discuss Coding Symptoms Versus Diagnosis
Author: Sims, Kimberly F
Source: Journal of AHIMA
Publication Date: January 2016
More than 60 million American adults experience heartburn at least once a month, and more than 15 million adults suffer daily from heartburn.1 Gastroesophageal reflux disease (GERD) occurs when the lower esophageal sphincter (LES) is weak or relaxes inappropriately, allowing the stomach’s....
Documentation Requirements for Reporting Professional Services
Author: Clark, Margi
Source: Brief Encounter
Publication Date: July 02, 2001
Here are some specific suggestions for improving the clarity and usefulness of physician record entries to support Evaluation and Management code levels.
History
Chief complaint with adjectives (8)
Site, description, severity, duration, timing (when) context (what is patient do....
Documentation Guidelines for E&M Services
Author: U.S. Centers for Medicare & Medicaid Services
Source: Government (U.S.)
Publication Date: May 09, 2006
Dangerous E/M Coding Practices: Identifying and Remedying Common Sources
Author: Stanfill, Mary H
Source: Journal of AHIMA - Coding Notes | Journal of AHIMA
Publication Date: March 2006
Code assignment for physician evaluation and management (E/M) services is inherently problematic because of the multiple coding rules and reporting guidelines that must be applied and the subjectivity of the codes. Consistent E/M coding practices are critical in the physician practice setting.....
CPT Updates for CY 2015
Author: Buttner, Patty
Source: Journal of AHIMA - Coding Notes | Journal of AHIMA
Publication Date: February 2015
On January 1, 2015, the updates to the American Medical Association’s Current Procedural Terminology (CPT) went into effect. The updates include 276 new codes, including three new Category II codes and 39 new Category III codes. There are a total of 129 revised codes and 137 deleted codes....
CPT Code Updates for 2013
Author: Miller, Jackie
Source: Journal of AHIMA - Coding Notes
Publication Date: January 2013
The CPT code set has undergone extensive revisions for 2013, with codes, guidelines, and modifiers being revamped and updated. HIM coding professionals should download and review the CPT 2013 errata on the AMA website before starting to use the new codes. This download can be accessed at w....
Common E/M Documentation Issues
Author: Udell, Curtis
Source: Brief Encounter
Publication Date: July 02, 2001
One of the constant challenges facing managers today is evaluating physician documentation and then helping their physicians to improve the content of their patient notes, particularly for evaluation and management (E/M) services.
While physicians may have unique style or flair to t....
Coding Trends of Medicare Evaluation and Management Services
Author: U.S. Department of Health and Human Services. Office of the Inspector General
Source: Government (U.S.)
Publication Date: May 15, 2012
Coding Preventive Care Services
Author: Wilkinson, Dianne
Source: Journal of AHIMA - Coding Notes
Publication Date: March 2008
According to the Partnership for Prevention—a program-based organization of businesses, nonprofits, and government agencies—“the U.S. health care system suffers a quality deficit in part because too many patients do not get the effective preventive care they need when they ne....
Clarifying Selected CPT Modifiers
Author: Scichilone, Rita A
Source: Journal of AHIMA - Coding Notes
Publication Date: April 2000
Coding for professional services is complicated enough when coding professionals are charged with assisting the physician to select the best five-digit number for the services rendered. It becomes even more complex when circumstances of the case require the CPT code to be modified. Add....
Casting Conundrum: Correct Coding for Casts, Splints, and Strapping
Author: Nelson, Tanai S; Benjamin, Christina
Source: Journal of AHIMA - Coding Notes
Publication Date: July 2009
Correctly coding casts, splints, and strapping can be confusing. Much of the confusion is related to what type of materials are classified as casts, splints, or strapping; whether the CPT application codes or the HCPCS level II codes should be assigned; and whether the work performed is includ....
Assigning Evaluation and Management Critical Care Codes
Author: Sims, Kimberly F
Source: CodeWrite
Publication Date: November 2015
Objective
The objective of this article is to outline the steps required to assign Evaluation and Management codes for critical care services.
Clinical Information
What is Critical Care?
Critical care can be defined as speci....
Assigning Advance Care Planning Codes
Author: Huey, Kim
Source: CodeWrite
Publication Date: May 2016
Physicians have a new opportunity to bill and be paid separately for a counseling service they may already be performing. Advance Care Planning codes 99497-99498 were introduced in Current Procedural Terminology (CPT®) in 2015 but were not paid by Medicare until January 1, 2016. CPT code 9....
AHIMA's Comments Regarding APC Advisory Panel Discussion on Guideline for Medicare OPPS - Facility Coding of E/M Services
Author: Prophet, Sue
Source: AHIMA testimony and comments
Publication Date: January 03, 2002
AMERICAN HEALTH INFORMATION MANAGEMENT ASSOCIATION
233 North Michigan Avenue, Suite 2150
Chicago, Illinois 60601-1090
January 3, 2002
Paul M. Rudolf, MD, JD
Chairman
Medicare Advisory Panel on APCs
c/o Centers for Medicare & Medicai....
AHIMA Letter to Secretary Sebelius and Attorney General Holder Concerning EM Coding in EHRs
Author: Gordon, Lynne Thomas
Source: AHIMA testimony and comments
Publication Date: September 26, 2012
AHIMA Comments on FY03 Medicare OP-PPS
Author: Rode, Dan; Prophet-Bowman, Sue
Source: AHIMA testimony and comments
Publication Date: October 03, 2002
October 3, 2002
Thomas A. Scully
Administrator
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-1206-P
PO Box 8018
Baltimore, Maryland 21244-8018
Re: File Code CMS-1206-P<....
2010 CPT Coding Update
Author: DeVault, Kathryn
Source: Journal of AHIMA - Coding Notes
Publication Date: February 2010
Changes to CPT codes for 2010 include 219 additions, 141 revisions, and 63 deletions. This article highlights some of the more notable changes; a comprehensive list can be found in appendix B of the 2010 CPT coding book. The changes took effect January 1.
Resequencing
The most n....
2007 CPT Coding Update
Author: Wiedemann, Lou Ann; Zeisset, Ann M.
Source: Journal of AHIMA - Coding Notes | Journal of AHIMA
Publication Date: February 2007
A number of changes to the current CPT codes took effect on January 1, 2007. These changes affect categories I, II, and III codes, with a total of 258 additions, 308 deletions, and 79 revisions. A summary of all additions, deletions, and revisions can be found in appendix B of the 2007 C....
2006 CPT Coding Update
Author: Hull, Susan
Source: Journal of AHIMA - Coding Notes | Journal of AHIMA
Publication Date: January 2006
A number of changes to CPT codes take effect January 1, 2006. These changes affect category I, II, and III codes, with a total of 277 additions, 110 deletions, and 71 code revisions.
Evaluation and Management
Within the evaluation and management (E/M) section, the codes for fol....
1997 Documentation Guidelines for E&M Services
Author: U.S. Centers for Medicare & Medicaid Services
Source: Government (U.S.)
Publication Date: January 02, 1997
This publication provides definitions and documentation guidelines for the three key components of E/M services and for visits which consist predominately of counseling or coordination of care.