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E&M PPT

The document outlines guidelines for Evaluation and Management (E/M) services, including components such as history, examination, and medical decision-making (MDM). It details coding for telehealth services, annual wellness visits, preventive care visits, vaccinations, consultations, observation services, incident to and split shared services, and prolonged services, emphasizing the importance of documentation and specific CPT codes. Additionally, it highlights the need for proper supervision and the conditions under which various services can be billed, particularly under Medicare guidelines.

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pranavie2002
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78 views

E&M PPT

The document outlines guidelines for Evaluation and Management (E/M) services, including components such as history, examination, and medical decision-making (MDM). It details coding for telehealth services, annual wellness visits, preventive care visits, vaccinations, consultations, observation services, incident to and split shared services, and prolonged services, emphasizing the importance of documentation and specific CPT codes. Additionally, it highlights the need for proper supervision and the conditions under which various services can be billed, particularly under Medicare guidelines.

Uploaded by

pranavie2002
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Evaluation and

Management (E/M)
E/M services can be rendered by any specialties. If there is no
document, we should not code by assumptions .

E/M Components

History
Examination Key Components
MDM

Time
Counseling 4 Contributing Factors
Co-ordination of care
Nature of presenting problem
Level of Selection
• Level of selection will be done based on MDM or time.

• Time: More than 50% of counseling co-ordination care


time spend with direct face- to- face with the patient. (
this format is required in IP)
• In regards to OP just time in minutes is enough ( EG:
60, 40, 30 minutes)
Telehealth Services
• Guidelines:
• Mode of the visit should be document
• Time of the visit should be document
• CPT 99441 , 99442, 99443.( Totally time based)
• 99441- 5 to 10minutes
• 99442 – 11 to 20 minutes
• 99443- 21 to 30 minutes

• 99202 to 99215
If the mode of visit is VIDEO code 99202
to 99215 along with 95 modifier

If the visit is AUDIO code 99441 to 99443


based on the time.

GT modifier is applicable for Medicare


( but totally depends on client guidelines.)
Annual Wellness Visit
• Guidelines: ( Totally coded on Medicare insurance)
• CPT- G0402, G0438, G0439
• G0402 – Welcome to Medicare
• G0438- Initial AWV
• G0439- Subsequent AWV

• To code G0402 we should check the Medicare enrollment date of the


patient.( can be coded only with in 12months of enrollment )
• G0402 is billable in once in life span.
• G0438 is billable after 12months of G0402
• G0439 is billable after 12months of G0438
• G0439 can be billed thought out the life in upcoming years.
Preventive Care Visit
• CPT: 99381 to 99387 ( New PT)
• 99391 to 99397( Estab PT)
• These are totally age based CPT.

• Along with IPPE( Initial Preventive Physical


Examination) if any other service has been rendered
give 25 modifier.
Vaccination & immunizations
• Guidelines
• Name of the vaccine
• Root of administration
• Dosage of the vaccine
• Laterality
• With or with out counseling

• With counseling CPT: 90460 and add on code is 90461( will add each
component)
• Without counseling CPT : 90471 to 90477( will add each vaccine)
• Each vaccine will be given based on the ROA( Root of administration)
Consultation Services
• Guidelines

• Medicare won't accept consultation services.


• Required RRR criteria to code
• Request, Render , Report.
• CPT: 99241 to 99244( New patient)
• 99251 to 99255 (estb patient)
•
Observation Services
Guidelines
• CPT: 99218 ,99219 99220
• 99217
• 99234,99235,99236

• 99218 to 99220 indicated the initial visit


• 99224 ,99225 and 99226 indicates subsequent visit.
• Different day admit and discharge indicate with 99217
• Same day admit and discharge code 99234 o 99236.
• If the patient is transferred to Hospital care from observation and discharged
then code 99238 or 99239( time based coded)
• 99238 requires 15 to 30minutes
• 99239 requires more than 30minutes.
“Incident to” & Split shared
services
• Guidelines

• Physician will supervise the services which will be


rendered by NPP or any clinical staff.
• In regard to “INCIDENT TO” supervising physician
physical presence is required.(applicable only for
estab PT with etab problem)
• In split shared services will use FS modifier.
Prolonged Services
• Guidelines
• All the time prolonged services will be coded along
with the highest level of the CPT.

• In regard to IP we require addictional + 30


minutes(99345,99355,99356 & 99357)
• In regard to OP we require addictional + 15
minutes( 99417 and G2212

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