Description

• Understand How Physicians and Hospitals Use E/M Codes
• Appreciate the Need to Audit E/M Coding and Judge Associated Documentation
• Appreciate Why E/M Coding for Telemedicine Is Different
• Learn About the CMS Facility E/M Coding Principles
• Understand the Difficulties with E/M Coding for the ED
• Appreciate How To Adjust to CMS Dropping the Consultation Codes
• Appreciate the Differences Between Specialty Clinic Coding and Primary Care Clinic Coding for E/M Services
• 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
• Understand How to Organize an E/M Coding Audit
• Understand the Importance of the “-25” Modifier
• Appreciate the Compliance Challenges Surrounding E/M Coding

Objectives of the session:

• To review the E/M codes as they appear in the CPT Manual.
• To discuss establishing an E/M coding audit and audit program.
• To appreciate the difference between ‘new’ versus ‘established’ patients for physicians and hospitals.
• To appreciate physician and hospital 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 appreciate the physician E/M documentation guidelines.
• 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.
• Understand the special situation of E/M coding for telemedicine.
• To explore how electronic health record systems create challenges for developing proper documentation to support E/M coding.

Agenda of the session:

1. Overview
   1. E/M Coding Under RBRVS
   2. E/M Coding Under APCs
   3. E/M Coding For Telemedicine
   4. E/M Codes – General Categories
   5. Physician Use of E/M Codes
   6. Electronic Health Record Systems
2. E/M Coding Guidelines
   1. Physician Guidelines
   2. Hospital Developed Guidelines
   3. Variations for ED and Provider-Based Clinics
   4. Consultation Code Issues and the “-AI” Modifier
3. CMS Coding System Principles and Guidance
   1. CMS Guidelines
   2. CMS Audit Criteria
   3. CMS Expectations
   4. Special Circumstances For Telemedicine Services
4. Planning An E/M Coding Audit
   1. Overall Objective
   2. Number of Cases For Selection
   3. Stratification of E/M Levels
   4. Use of OIG’s RAT-STATS Program
   5. Audit Guidelines
   6. Developing Recommendations
   7. Assessing Impact of Electronic Health Record Computer Systems
   8. Report Writing and Recommendations
5. Case Studies/Exercises
6. Sources for Further Information

Who should attend?

• Clinic Managers
• Clinic Administrators
• Coding Personnel
• Billing and Claims Transaction Personnel
• Nursing Staff, Clinical Service Area Personnel
• Chargemaster Coordinators
• Financial Analysts
• Compliance Personnel
• Physicians
• Non-Physician Practitioners
• Healthcare Auditors and Other Interested Personnel