The document discusses evaluation and management (E/M) coding guidelines. It covers the key components of E/M codes which are history, examination, and medical decision making. E/M codes are used to bill for office visits, hospital visits, consultations, and other services. Assignment of the codes depends on factors like new vs. established patient, type of service, place of service, patient age, and time spent. History, examination, and medical decision making are the three main components used to determine the level of E/M service provided.

2.  It covers patient disease, history, exam, and
MDM(medical decision making).
 80% of cpt codes covers E/M services.
 Assign E/M code whenever there is a documentation
of history examination and MDM.
 E/M code covers 10k-6k series with respective
modifiers

3.  Based upon place of service(office visits,hospital
visits,consultations)
 Based upon age
 Time taken for assessment
 Office visits again subdivided as new patient(or)
established patient
 Hospital visits again sub divided as initial(or)
subsequent patient.

4.  If time dominates a visit(taking too much time in
assessing a patient) assign separate code with respect
to time.
 Classification is very important because nature of work
varies based on type of service place of service and
patient condition.

5.  7 major components
 History
 Examination
 MDM(medical decision making)
 Time
 Counseling
 Co-ordination of care
 NPP(nature of presenting problem)

6.  First 3- components are key components
 Rest of 4- components are contributory components.
 LEVELS OF E/M SERVICE:-
it designed as
i. Giving unique code number
ii. Mentioning place/type of service provided
iii. Content of the service
iv. Finding present problem
v. Time taken for MDM decision.

7.  New patient visit requires more time than established
patient
 More resources are required for new patient
 For new patient Payment may be 40% higher than
established patient
 Separate codes are available for new and established
patients
 Patient come back within 3 years of time considered as
established patient

8.  3 years is the considering factor
 Absence of specification assume it as established
patient
 HOW TO ASSIGN E/M CODE?
 Analyze the patient(new/established)
 Place of service
 Age
 Time
 Key components

9.  8- elements are listed they are
 Location
 Duration
 Severity
 Quality
 Associated signs&symptoms
 Time
 Modifying factors
 context

10.  If 3- elements are documented, (HPI is brief)
Example: abdominal pain since morning due to
spicy food
 If more than 3- elements documented,(HPI is
expanded).
Example :edema of both legs due to ckd with
diabetic foot since 4 months and k/c/of
diabetic&hypertension since 5 years.

11.  Payment difference for every element is 10 dollars.
 Pay&chase model:-insurance company pay first later
on chase.
 Self-disclosure scheme:-under this scheme physician
can declare self errors and publish there by refunds the
money to insurance companies

12.  It is a questionnaire where patient has to respond
 There are 11- ros are there:-
 EYE
 ENT
 Cardiovascular
 Respiratory
 gastrointestinal

13.  Genitourinary
 Musculoskeletal
 Integumentary neurological
 neurologic
 Psychiatric
 Hematologic/lymphatic

14.  Physical exam is objective evidence
 ROS is subjective evidence
 NATURE OF PRESENTING PROBLEMS
 They are 5-types
 Minimal
 Self-limited
 Low severity
 Moderate severity
 High severity

15. HISTORY EXAMINATION MDM(LEVEL)
PROBLEM
FOCUSED
PROBLEM
FOCUSED
STRAIGHT FORWARD
EXPANDED EXPANDED LOW LEVEL
COMPLEXCITY
DETAILED DETAILED MODERATE LEVEL
COMPLEXICITY
COMPREHENSIVE COMPREHENSIVE COMPREHENSIVE

16.  Physical exam is done by four ways
 Inspection(seeing)
 Palpation(touching)
 Auscultation(hearing)
 Percusion(tapping)

17.  There are 2- types of guidelines for E/M coding
 1995-guidelines
 1997-guidelines
 Cpt book has 1995-guidelines
 Auditors preffers 1997-guidelines
 1995-guidelines based on history and MDM
 1997-guidelines based on bullet points

18.  If there is no specific mention code as established
patient
 Considering three key factors(history/exam/MDM)
 If a level is not matching, as per CPT guidelines drop
the level

19.  For new patient 3/3 levels should be match
 For established patient2/3 levels is minimum
 Dollar value depends on
physician+practice+malpractice insurance.

20.  Time is a considering factor for E/m services
 It includes both new/established patients
 Minimum 8- hours are required for discharging a
patient on same day
 Day-1 considered as initial hospital care
 Dy-2 is subsequent day
 Discharge is based on time.

21.  It is a type of service, in this service one physician can
refer another physician for a specific condition
 Consultant physician can start diagnosing the patient
or therapeutic services subsequently.
 Such services are reported under office visit,home
service,etc….
 Written format for consult physician may made by a
physician are documented in patient medical records..

22.  This code are given only when treatment or services
done in emergency department.
 Case must be seen by emergency physician
 Emergency department must be 24/7
 New/established patients included.
 Critical care services provide in ED reported separately

23.  Time is not a discriptive factor in ED
 ED service coding given based upon intensity.
 It may involves multiple encounters
 So time is not a considering factor

24.  Critical care is given by direct physician or any other
health care professionals
 Monitoring vital signs are very important
 It requires high complexity decision
 It depends on total duration of time
 If less than 30- minutes use appropriate E/M services.

25.  Critical care provided to 29 days to 71 months
 code from pediatric critical care.
 Critical care is provided with other E/M services code
separately
 Range of code 99291-99292.

26.  Nursing facility service codes given when E/M services
are at skilled nursing facilities.
 This codes also used for psychiatric residential
treatment center.
 If any other services are along with this code
separately.

27.  Prolonged services without direct patient codes are
99358-99359.
 Preventive medicine services are include
infants,children, and adults
 Range of code for new patient 99381-99387
 Range of code for established patient 99391-99397
 Telephonic services are not face-to- face services

28.  Telephonic services are given through telephone
 Range of code 99441-99443
 On line medical evaluation is by physician to patient
through internet sources
 Range of code 99444
 https://www.medesunglobal.com/

29. THANK YOU