ED Coding & Reimbursement Alert - 2020 Issue 8
E/M Coding: Bolster E/M Claims With HPI Calculation Advice
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Article Overview
This article explains how documentation support affects evaluation and management (E/M) claims, with emphasis on history of present illness (HPI) review, payer expectations, and the interaction between CPT guidance, CMS recognition, and the 1995/1997 E/M documentation frameworks. It is aimed at coders, auditors, and clinical documentation staff who need a refresher on what broad documentation categories are discussed in the article so they can judge whether the full piece is relevant to their work.
Why This Topic Matters
E/M documentation remains a frequent audit and compliance focus, and understanding the article’s scope helps readers assess whether they need guidance on HPI interpretation, chronic-condition documentation, and payer-specific documentation standards.
Article Sections
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Overview and documentation context
Introduces the article’s focus on E/M documentation and the need to stay aligned with current and upcoming requirements. It frames the discussion around documentation completeness and payer considerations.
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HPI fundamentals
Summarizes the role of HPI within the history component of E/M selection and reviews the broad categories of HPI elements and levels. It also references the relevant documentation frameworks discussed in the article.
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Myth 1: Just Listing the HPI Element or Chronic Condition Is Sufficient
Addresses a common documentation misconception involving HPI element entry and chronic-condition documentation. The section focuses on the need for adequate supporting detail.
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Myth 2: Duration Is Not Regarded as an HPI Element
Compares how different guidance sources treat HPI element recognition and discusses payer guidance awareness. It emphasizes checking how a payer recognizes documentation elements.
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Myth 3: You Can Document Chronic Conditions Instead of HPI
Discusses how chronic-condition status documentation relates to HPI under different guideline sets. The section also notes the importance of who obtains and documents the history portion.
What You Will Learn
- How the article frames HPI within E/M documentation
- What broad HPI documentation categories are discussed
- How payer and guideline differences affect documentation review
- How chronic-condition status is discussed in relation to HPI
- Why provider participation in history documentation is emphasized
Who Should Read This
- Medical coders
- Coding auditors
- Compliance staff
- Clinical documentation staff
- Physician practices
- Part B billing teams
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