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E/M Coding and the Documentation Guidelines: Putting It All Together


Evaluation and management (E/M) services refer to diagnostic/therapeutic management of the patient furnished by healthcare providers. The Center for Medicare and Medicaid Services (CMS) has found E/M services vulnerable to fraud and abuse. Scrutiny from the OIG, government-contracted, and third-party auditors makes it especially important to keep your E/M coding skills current and up to date.

CMS requires healthcare providers to accurately determine the appropriate complexity level of an E/M service, corresponding to the amount of skill, effort, time, responsibility, and medical knowledge required for the healthcare provider to deliver the service to the patient. In addition to the AMA & CMS guidelines for E/M code selection, there are also various policies, coverage determinations, and requirements that must be considered for each major payor.

This course is relevant for providers, clinical, and practice staff involved in diagnostic and procedural coding, medical coders, consultants and office managers are encouraged to attend. Learn coding rules and documentation guidelines relevant to proper E/M code selection. Attend this informative session to master the process of accurately determining the appropriate E/M code level for services and improve your understanding of the criteria that are utilized in making the determination.

The instructor will bring clarity to distinctions regarding new vs. established patient guidelines and coding E/M services based on time vs Medical Decision Making (MDM). Find out what non-face to-face work is to be included in total time and gain details on the time ranges. Learn when and how to use the CPT prolonged services code(s) and when to use office and outpatient visit codes without an add-on prolonged care code based on time.

Highlights:

  • Review essential coding guidelines for E/M services to ensure proper claims submission
  • Understanding the role of history and exam
  • Medical Necessity and Nature of the Presenting Problem
  • Coding based on time; what is included and excluded?
  • Review reporting rules for prolonged services
  • Receive coding tips and strategies for successful documentation and claims submissions

Full Schedule


There are no programs scheduled at this time


CEUs:

PMI 3

Target Audience

This course is appropriate for providers, clinical, and practice staff involved in diagnostic and procedural coding. Beginning and certified coders alike will benefit from this course. Consultants and office managers are also encouraged to attend.