decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 12 (December)
Put these E/M Q&As to work in your practice
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Article Overview
This article reviews a selection of 2009 evaluation and management coding questions answered by a CPT Editorial Panel vice chair. It focuses on broad coding and reimbursement issues affecting preventive medicine, E/M guideline application, and prolonged services, making it relevant to coders, compliance staff, and clinicians who work with office, facility, and other E/M scenarios. The discussion also touches on payer policy considerations and changes being contemplated for CPT guidance.
Why This Topic Matters
It helps readers understand how common E/M coding questions were being discussed in CPT educational settings and why similar scenarios may require payer-specific review or careful attention to documentation and code selection.
Article Sections
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Preventive medicine
Questions and answers in this section address preventive medicine encounters and related documentation and reporting concerns. It discusses how these issues intersect with payer review and related service categories.
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E/M guidelines
This section covers a question about provider type, coverage, and whether an evaluation and management service may be payable under a health plan. It focuses on general guideline application rather than detailed coding mechanics.
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Prolonged services
Questions in this section examine prolonged service concepts in different settings, including time basis, base service relationships, and published examples. It also notes discussion of future clarification to CPT guidance.
What You Will Learn
- How the article frames common E/M questions in a CPT Q&A format
- Which broad E/M topics were addressed in the 2009 symposium discussion
- How prolonged services issues were being clarified for different care settings
- Why payer policy and provider recognition can affect reimbursement for E/M services
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physicians and other clinicians
- Practice managers
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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