FindACode.com is pleased to announce the publication of a new special report: "Integrating NPP into E/M".
This brief but critical guide on Evaluation and Management coding is written by Dr. Stephen R. Levinson author of the AMA's "Practical E/M: Documentation and Coding Solutions for Quality Patient Care."
While the CMS documents provide details of the three “key components” of the E/M system, thorough understanding of compliant E/M documentation and coding must necessarily include consideration of the Nature of the Presenting Problem(s) (“NPP”), an additional E/M component that the AMA publication “Current Procedural Terminology” (CPT®) identifies as one of three “contributory factors.”1 This is because “the NPP is the CPT coding system’s E/M vehicle for evaluating medical necessity,”2 and as explained by the Centers for Medicare and Medicaid Services (“CMS”), “Medical Necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code.”3 This principle derives from Social Security Law, which mandates “Medicare will not pay for services that are not medically necessary.”4 Therefore, submission of a high level of E/M service is not warranted if the presenting problem has relatively low severity of NPP (e.g., a sprained ankle, a viral upper respiratory infection, or an uncomplicated urinary tract infection), even if there has been extensive documentation of medical history, physical examination, and medical decision making (the three key components). This is because the NPP fails to support the medical necessity of these high levels of care.
The following excerpts quoted from the American Medical Association’s own publication about E/M compliance clarify the concept of the nature of the presenting problem and explain how physicians should incorporate this concept into both patient care workflow and compliant documentation and coding.
Click here to view the entire report.
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Footnotes: 1 American Medical Association, Current Procedural Terminology (CPT®) 2011, Professional Edition, AMA Press, 2010, page 6 CPT is a registered trademark of the American Medical Association. 2 Levinson, Stephen R., M.D., Practical E/M: Documentation and Coding Solutions for Quality Patient Care, second edition, AMA Press, 2008, page 47 3 Medicare Claims Processing Manual, Chapter 12, Section 30.6.1 4 Social Security Law, section 1862