This workshop explores E/M coding for both physicians and hospitals and include a brief discussion of consultation codes for telehealth. Documentation issues and challenges relative to auditing E/M coding discussed for both physicians and hospitals. Compliance issues and concerns are discussed relative to E/M coding. The use and misuse of the “-25” modifier along with other modifiers surrounding E/M coding the global surgical package. Audit techniques are outlined relative to assuring proper compliance with E/M coding.

Possible changes to E/M coding for Medicare for CY2019 will be addressed. While significant changes for the office visits (99201-99215) have been proposed, the final changes will be announced in the first half of November, 2018.

Understand How Physicians and Hospitals Use E/M Codes
Appreciate the Need to Review E/M Coding and Judge Associated Documentation
Learn About the CMS Facility E/M Coding Principles and the G0463
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 for Either Physicians or Hospitals
Understand the Importance of the “-25” Modifier
Appreciate the Compliance Challenges Surrounding E/M Coding
Learn About Changes in Office Visit for Medicare for CY2019
Session Objectives:

To review the E/M codes as they appear in the CPT Manual.
To explore different guidelines that are used by physicians and hospitals.
To understand the use of G0463 and BBA 2015 Section 603 clinics.
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 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.
To explore how electronic health record systems create challenges for developing proper documentation to support E/M coding.
To review changes that are being made for office visit E/M codes for Medicare starting in 2019.
Session Agenda:

Overview
E/M Coding Under RBRVS
E/M Coding Under APCs
E/M Codes – General Categories
Physician Use of E/M Codes
Electronic Health Record Systems
Update to Office Visit Codes for Medicare
CMS Proposal for Special G-Codes
Changes in Documentation Guidelines
E/M Coding Guidelines
Physician Guidelines
Hospital Developed Guidelines
G0463
BBA 2015 Section 603 Clinics
Variations for ED and Provider-Based Clinics
Consultation Code Issues and the “-AI” Modifier
CMS Coding System Principles and Guidance
CMS Guidelines
CMS Audit Criteria
CMS Expectaion
Planning An E/M Coding Audit
Overall Objective
Number of Cases For Selection
Stratification of E/M Levels
Use of OIG’s RAT-STATS Program
Audit Guidelines
Developing Recommendations
Assessing Impact of Electronic Health Record Computer Systems
Report Writing and Recommendations
Case Studies/Exercises
Sources for Further Information