Medicare Compliance & Reimbursement - 2020 Issue 11
E/M Coding: Check This Advice to Report Low-Level E/M Encounters
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Article Overview
This premium coding article focuses on low-level emergency department evaluation and management reporting. It is aimed at coders, auditors, and clinicians who need a clearer view of how documentation, encounter complexity, and provider setting affect the selection of a low-level ED E/M service. The article reviews general documentation requirements, compares older E/M documentation guideline versions at a high level, and discusses when services furnished by nonphysician providers in the hospital setting may be relevant.
Why This Topic Matters
Low-level ED encounters are easy to undercode or overcode when documentation is sparse or when the service is furnished by different types of providers. Understanding the scope of the article helps readers assess whether their ED documentation and reporting practices align with common audit concerns.
Article Sections
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Know what it entails
Introduces the low-level ED E/M service discussed in the article and summarizes the general components used to evaluate whether the encounter is supported.
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Uncomplicated Issues May Warrant 99281
Discusses the kinds of ED presentation scenarios that may be associated with this level of service and highlights documentation and utilization considerations.
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Check the Documentation Requirements
Reviews the documentation framework for the service, including a high-level comparison of guideline versions and the broad elements used to support the encounter level.
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Must the Physician See the Patient?
Addresses provider setting and billing context for care furnished by nonphysician practitioners in the hospital environment.
What You Will Learn
- How low-level emergency department E/M encounters are described at a general level
- What broad documentation elements are reviewed for support of the service
- How older E/M documentation guideline versions are discussed in the article
- How provider type and hospital setting can affect reporting context
Who Should Read This
- Medical coders
- Coding auditors
- Emergency department billing staff
- Clinicians documenting ED encounters
- Compliance teams
Codes Discussed
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