evaluation and management coding e&m coding - university of 评估和管理编码e &；m编码-大学.ppt

Power of the Pen,Iyad G. Houshan. M.D. Assistant Professor of Medicine Chief, Division of Hospital Medicine University of Nevada School of Medicine,ICD-9 codes,40 y.o. male with PMHx of 250.4, 272.4, 496, here for 491.21 exacerbation and possible 410. How do you treat this patient? 40 y.o. male with PMHx of DM ( renal manifestations), dyslipidemia, COPD, here for COPD exacerbation and possible MI.,Evaluation and Management Coding “E&M Coding”,Why I’m I here?Can I pay some one to do that for me?What is my incentive to learn this?,INCENTIVE,Definitions,ICD-9 : International Classification of Diseases. ( 250.00, 272.4,…) CPT : Current Procedural Terminology CMS : Centers for Medicare and Medicaid Services,Definitions, Cont’d,E&M codes, Like CPT codes are compromised of five digits. E&M codes specifically begin with 99. E&M subsequent numbers depend on the type of E&M.,Definitions, Cont’d,A level 1 ( last digit a 1) is the least A level 2 ( last digit a 2) is greater The highest code level will end in a 3 ( an inpatient hospital admission), or a 5 (Outpatient or consultations).,E&M Coding,Each individual code listed has three components that qualify physicians to work for the specific code:1) History2)Physical3) medical decision making MDM,E&M coding, cont’d,To add a degree of confusion to our coding dilemma, there are actually two sets of the Federal Documentation Guidelines for Evaluation and Management Services.,E&M coding, cont’d,The original set , 1994, affected primarily the history component of the physician documentation The second set, 1997, uses the same history segment but adds physical exam documentation guidelines, featuring the now infamous “bullet” points. Best to use the 1997 guidelines. ( we use the 1994 guidelines),E&M coding, cont’d,In the CPT book, when looking up a specific E&M code, the three listed qualifiers: History, Physical, and MDM are found Physicians don’t think code first. We think clinical matters, diagnoses, labs and tests, and history and physical. Taking care of the patients first before the codes.,The Game,,,,Documentation,Coding Level,The Game,,,,Documentation,Coding Level,Medical Necessity,Medicare will not pay for anything unless “Medical Necessity” is met,Medical Necessity is not clinical at all it is financial term,Code Qualifiers,Each Code,,,,MDM,History,Physical Exam,,,,,,,Risk,Data,Diagnosis,HPI,ROS,PMFSH,Elements in organ systems,,*Medical decision Making*,It has three components: Risk, Data, and Diagnosis.Remember complexity of MDM is the lowest of the two highest,*MDM*,Risk:High: “Severe” exacerbation of chronic illness. Acute illness threatening life or lim, Abrupt change in neurological status, Ordering of CV angiography, endoscopy with risk factors, pt needs emergent major surgery, Parenteral controlled substances, DNR decision.,*MDM*,RiskModerate: mild exacerbation, progression, 2 or more stable chronic illnesses, acute illness with systemic symptoms ( pyelonephritis, colitis,), ordering of stress test, ednoscopy without risk factors, needle biopsy; pt needs elective major surgery, prescription drug management, IV fluids with additives,*MDM*,DataReview, order lab……………1 pointReview, order Radiology……1 PointOther tests……………………1 PointObtaining old records…………1 PointReview and summaryof old records………………….2 PointsIndep. Interpretation of test….1 PointDiscussion of unexpected result with interp doctor………1 PointMAX POINTS = 4,*MDM*,Diagnosis:# of new or chronic self limitingproblems…………………Max 2 pointsPresenting problemimproved, well controlled #_X1=Inadequate control, worsening #_X2 =New problem no work up……3 pointsNew problem with work up planned 4 pointsMAX POINTS=4,LOWEST,OF THE TWO HIGHEST( new patient visits),Complexity of MDM,,Code Qualifiers,Each Code,,,,MDM,History,Physical Exam,,,,,,,Risk,Data,Diagnosis,HPI,ROS,PMFSH,Elements in organ systems,,*History*,CC : “ why are you seeing this patient HPI 1-3 elements= brief, 4 elements or comment on 3 chronic conditions= extended PMFSH 1 of 3 categories=pertinent3 of 3 categories=complete ● ROS= 1 problem pertinent2-9 extended10 complete,LOWEST,OF THE TWO HIGHEST,*History*,Code Qualifiers,Each Code,,,,MDM,History,Physical Exam,,,,,,,Risk,Data,Diagnosis,HPI,ROS,PMFSH,Elements in organ systems,,*Physical Exam*,Problem focused Examination: one to five elements in one or more systems Extended Problem Focused Examination: exam of at least 6 elements in one or more systems Detailed: for a general exam 2 elements in 6 organ systems or 12 elements in at least 2 organ system Comprehensive: 2 elements in 9 organ systems,*Physical Exam*,Organ systems (14) -Eyes -Constitutional -Neck -E,N,Mouth,throat -Chest, including -CVSBreast and axilla -G.I. -Respiratory -Lymphatic -Genitalia,groin, -SkinButtock -Psychiatric -Musculoskeletal -Neurologic,LOWEST,OF THE TWO HIGHEST,Initial Hospital Visits,99221 : Level I, LowDetailed or comprehensive history and exam, low complexity MDM 99222 : Level II, ModerateComprehensive history and exam, Moderate complexity MDM 99223 : Level III, HighComprehensive history and exam, High complexity MDM,。