Do You Know the 6 Steps of ‘Accurate’ E/M Coding Ladder ?
The revisions of CPT® coding are relentlessly spawning codes, especially in the E/M (Evaluation and Management) category. Approximately 80% of all charge tickets incorporate E/M codes, yet it seems to be an arduous task for the coders to confront with.
There are manifold factors that provoke this issue:
- Copious procedures reported, belong to this category
- Scant acquaintance with CPT® updates
- OIG’s E/M-specific audits
- Intricacy in E/M code selection
Factual Snapshots on E/M Coding :
According to the available Medicare data between 2001 and 2010:
- Medicare payments for E/M services escalated by 48 percent, i.e., from $22.7 billion to $33.5 billion.
- The number of E/M billing too increased by 13 percent, from 346 million to 392 million.
- The average Medicare payment per E/M service elevated by 31 percent, from roughly $65 to $85.
Viable Steps to Shine light on Shady E/M Coding !
The rules of Evaluation and Management coding are extensive and hence achieving a high degree of accuracy in E/M coding is cumbersome. The American Medical Association (AMA) recommends six valuable tips to pick the right E/M Code for the service rendered by you.
1. Spot the Apt Category and Sub-category of Service
With an effort to overhaul the E/M system, the AMA has categorized the E/M codes to define an extensive difference in skill, effort and time. This classification aids prevent, diagnose and treat infirmity or injury and promote optimal health. Coding experts urge closely reading the E/M Guidelines in the beginning of the CPT manual as well as the special instructions incorporated under each E/M coding category and sub-category to know the ropes of categorization. It must be noticed that, while all of the E/M codes are reportable, reimbursement policies may vary from payer to payer.
2. Read, Understand and Follow the Appropriate Reporting Instructions
After choosing the most pertinent category and subcategory of service, the “reporting instructions” in the CPT Coding Manual should be read clearly to identify the suitable code and perform proper reporting. Besides, information regarding the patient’s admission in various sites must be reported out-and-out as per the CPT directives.
3. Define the Level of E/M Service
It is crucial to ascertain the level of Evaluation and Management (E/M) Service which is based on three key (primary) components and four exceptional (secondary) components:
Key Components
- History
- Examination
- Medical Decision Making
Exceptional Components
- Time
- Counseling
- Coordination of Care
- Nature of Presenting Problem
4. Recognize the Extent of History Obtained
Follow the AMA guidelines to recognize the types of history with the applicable elements:
5. Determine the Degree of Examination Performed
Further to the assessment of history, the degree of examination must be determined. The AMA defines the levels of E/M services, based on four types of examination as follows:
Problem Focused – a restricted examination of the affected body area or organ system.
Expanded Problem Focused – a restricted examination of the affected body area or organ system and other symptomatic or related organ system(s).
Detailed – an extended examination of the affected body area(s) and other symptomatic or associated organ system(s).
Comprehensive – a broad multi-system examination or complete examination of a single organ system.
6. Measure the intricacy of Medical Decision Making
Medical decision making denotes the complexity of establishing a diagnosis and/or choosing a management option as measured, based on the following criteria:
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