Evaluation and Management Coding: Maximizing Reimbursement Claims – Jacqueline Bauer

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Evaluation and Management (E&M) Coding is frequently one of the most challenging areas for medical coders, and at the same time are the most common codes used for services being billed. Discover how to correctly determine proper use of CPT® codes, whether to use 1995 or 1997 guidelines, and what to look for in the notes to ensure reimbursement.

Explore advantages and disadvantages of allowing the EHR to choose codes for you. Identify correct definitions of CPT® terms used and review all parts of the E&M section of the CPT® book (be sure to have your own CPT® book!). Walk away with the confidence to correctly utilize E&M codes the first time to maximize reimbursement.

1. Identify the difference between consultations and transfer of care
2. Determine proper service level based on key components
3. Apply critical care codes correctly
4. Develop strong documentation that will back your billing
5. Reduce your risk of up coding/fraud/abuse
6. Distinguish when to use 1995 vs 1997 guidelines

Terminology

• New patient
• Established patient
• On call for another physician
• Consultation
• Transfer of care
• Oversight services
• Additional important terms

Services

• Location
  • Outpatient
  • Office
  • Hospital observation
  • Hospital inpatient
• Type
  • New vs. established patients
• Level
  • Key components to select service level
    • History
    • Examination
    • Medical decision making
• Modifiers

Critical Care

• 10 commandments of critical care

Documentation