E/M Documentation and Coding Articles and Resources
News and Important Information
E/M Changes Coming Our Way in 2023! 2022/07/12
AMA- CPT® Evaluation and Management (E/M) Changes eff 01/01/23
AMA -CPT® Evaluation and Management (E/M) Changes eff 01/01/21
Important Changes to Shared/Split Services 06/16/2021
Critical Evaluation and Management Changes Recently Announced by AMA 2021/03/16
1997 Documentation Guidelines for Evaluation and Management Services
1995 Documentation Guidelines for Evaluation and Management Services
Resources
Code Sets
Find-A-Code's Tools & Resources
Additional Links and Resources
E/M Webinars
Select the title to see a summary and a link to the full article. some articles require a subscription to view.
Jan 10th, 2023
E/M Transformations and Clarifications Eff January, 1 2023
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Pay close attention to the new code description changes when coding E/M in 2023, the changes keep coming. Several codes have been consolidated, revised, or deleted. Learn what to look for in this article.
Jan 3rd, 2023
2023 Procedure Coding Updates Are Just Weeks Away
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Even with such a low number of code changes headed our way in 2023, the talk is all about Evaluation and Management (E/M) and speculation about whether our facilities will be able to meet the challenges associated with such a big change. In 2021, when the initial round of E/M changes were announced, they were backed up with a couple of years to prepare for implementation but for facility, it was just months.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Each year coding updates are published and more often than not, there can be anywhere from a few hundred to over a thousand new, revised, or deleted codes changes. Coders who take the time to review all of the changes instead of just those pertinent to their organization will accumulate knowledge and experience that helps them stand out in the coding industry as experts.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
This will be the third time since 2021 that the diagnosis complexity definitions have undergone significant changes. The initial 2021 changes were specific to Office and Other Outpatient E/M services and due to some confusion surrounding a few of the guidelines, updates to them were published by the AMA in April of 2021 with an effective date of January 1st. Because the 2023 E/M changes are more focused on the remaining E/M categories, especially in the hospital facility, new definitions were added and old definitions changed.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
The 2023 Evaluation and Management changes have been published and efforts are ongoing to educate coders and provider organizations on the guideline and code description changes that will impact professional coding in the facility setting. These changes required a significant revision to the guidelines and definitions of the various levels of complexity associated with the Number and Complexity of "Problems Addressed" during an encounter, which is the first element of medical decision making (MDM) and the following explanations and examples should provide a greater understanding of the changes headed our way in January.
Oct 24th, 2022
2023 Evaluation & Management Updates Free Webinar
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Congratulations on a successful 2021 implementation of the Evaluation and Management (E/M) changes! That was a big change, but now an even bigger change is headed your way for inpatient and all other E/M categories. How great is it that almost all of the E/M categories will now be scored based on medical decision making (MDM) or total provider time? Standardized scoring and one set of E/M guidelines has the potential of bringing about a change or improvement of provider fatigue due to over regulation and documentation burden.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
In just a few short months, major revisions to the remaining Evaluation and Management categories in the Current Procedural Terminology (CPT) code book will go into effect. How many of these changes will affect your organization and how ready are you for them? While the changes to the remaining E/M categories will closely resemble the 2021 changes to the E/M Office and Other Outpatient (99202-99215) codes, there are some major differences that need to be carefully reviewed, such as how E/M will change for the Emergency Department services.
Jul 12th, 2022
E/M Changes Coming Our Way in 2023!
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Changes are one thing we can count on being consistent; even though this is one we have been anticipating, it is time to prepare, and we will have some work to do. The AMA released the new 2023 E/M Guidelines early to help us prepare for the change effective January ...
by CMS - MLNConnects
News - COVID-19: New Administration Code for Pfizer Pediatric Vaccine Booster Dose - - Biosimilars: Interchangeable Products May Increase Patient Access - - Critical Care Evaluation & Management Services: Comparative Billing Report in May - -...
Jun 1st, 2022
Reporting CCM and TCM Codes with E/M Codes
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
When reporting CCM or TCM codes, you will only get reimbursed for what is allowed. The E/M office visits can be coded in addition but are not interchangeable with CCM codes. You can bill an E/M visit during the time a patient is under Care Management, however, you can’t count time ...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Have you already implemented a care management services program in your provider organization? If not, now may be the time to seriously consider doing so. Significant 2022 changes to the codes and increases in RVUs and reimbursement rates creates an opportunity not only to improve patient care for chronic conditions but will also help your practice increase revenues if done correctly.
by Terry Fletcher, CPC CCC CEMC CCS CCS-P CMC CMSCS CMCS ACS-CA SCP-CA QMGC QMCRC
Choosing a proper office visit code can become confusing unless one understands the rules separating preventive medicine and evaluation and management (E&M) coding. Problem-oriented E&M services, office, and other outpatient visit codes 99202-99215 (along with hospital, observation, and consultative encounters) are for patients who present with signs, symptoms,...
May 5th, 2022
Moving to Medical Decision-Making as the Key Component
by Erica E. Remer, MD CCDS
Office billing is now based solely on either MDM or total time. Last week, I declared that it is my opinion that medical decision-making (MDM) should always be one of the components that contributes to selecting (or perhaps, demonstrating) the appropriate level of service (LOS) for the professional...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
The 2021 Comprehensive Error Rate Testing report provides important lessons on exactly what errors are being found during chart reviews and how provider organizations can be proactive in their approach to quality documentation that not only supports the services provided to the patient but allows the providers to work in an environment of knowing what must be documented to support what they submit to the payer.
Feb 24th, 2022
Prolonged Services Billed As a Split/Shared Visit
by Raquel Shumway
According to the new Medicare’s 2022 Medicare Physician Fee Schedule Final Rule (MPFS) in some cases, Prolonged Services can now be billed as a split/shared visit.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Medicare is making changes to the reporting guidelines for split or shared services. Some important changes have already gone into effect as of January 1, 2022 and others are scheduled to go into effect in 2023. If your organization reports split or shared services, it’s time to look more closely at how the new rules will affect your compliance policies and reimbursement.
by Raquel Shumway
Critical Care Services — Medicare's final ruling has been released. This article discusses the changes to critical care services, including bundled services, concurrent services, global surgery, time spent performing CCS services, and documentation requirements. It also lists the two new modifiers.
Feb 10th, 2022
SDoH Improves Reimbursement and Risk Scores
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
The new guidelines for evaluation and management (E/M) services 99202-99215 refer to social determinants of health (SDoH) on the new or revised Table of Risk. Healthcare professionals have long hoped for the ability to score these problematic patient conditions in a meaningful way, not only for reimbursement, but also for quality of care and treatment options. SDoH codes recently added to the ICD-10-CM codeset continue to impress upon us the importance of identifying and reporting these patient issues and when combined with the new table of risk for scoring the E/M service, can impact reimbursement and care.
Feb 8th, 2022
Will Your Critical Care Services Pass An Audit?
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Critical Care Services (CCS) have unique guidelines which may vary between payers. This article explores these differences to help providers to understand what needs to be documented in order to support medical necessity and meet the criteria for the code description.
Jun 16th, 2021
Important Changes to Shared/Split Services
by Wyn Staheli, Director of Content - innoviHealth and Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Reporting of split (or shared) services has always been wrought with the potential for incorrect reporting when the fundamental principles of the service are not understood. A recent CMS publication about these services further complicates the matter.
Select the title to see a summary and a link to the full webinar information. some webinars require a subscription to view.
Jan 12th, 2023
2023 Annual Update Summary
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Be sure you are ready for 2023 with this review of the upcoming coding and reimbursement updates for 2023. This informative webinar discusses changes to CPT codes and guidelines including a summary of the changes to E/M services and an overview of changes to other CPT categories.Oct 6th, 2022
2023 CPT Evaluation & Management Updates
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Jul 7th, 2022
Dealing with the Little Coding Conundrums
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
May 5th, 2022
Do Minor Procedures Feel like Major Work?
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Apr 14th, 2022
Reporting Telemedicine Services by Aimee Wilcox
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Nov 10th, 2021
Scoring E/M Services Based on MDM
by Wyn Staheli, Director of Content - innoviHealth and Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Apr 7th, 2021
AMA Announced New E/M Guideline Changes on March 9, 2021 Retroactively Effective to January 1, 2021
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Jul 30th, 2020
Evaluation & Management Coding Rules are Changing in January - Is Your Organization Ready?
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Nov 7th, 2019
Preparing for E&M Changes in 2021
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Feb 21st, 2019
E/M and the Organ Systems Part 2 of 2
E/M and the Organ Systems Part 2 of 2
Feb 7th, 2019
E-M and the Organ Systems (Part 1)
E-M and the Organ Systems (Part 1)
Dec 13th, 2018
Coding Auditing Evaluation and Management and 2019
Coding Auditing Evaluation and Management and 2019
Apr 12th, 2018
Evaluation and Management Coding and Auditing
by Find-A-Code™
Are you responsible for selecting or reviewing Evaluation and Management service levels? Do you wonder how well you know the rules and how to apply them? Join Aimee in this webinar to review and then applly the rules of E/M coding. She will also do a live demonstration of the new Find-A-Code E/M Calculator Tool to assess the level of E/M service for two office visits, one new (99201-99205) and the other established (99212-99215).by Find-A-Code™
Do your providers perform and report Evaluation and Management (E/M) services in the inpatient setting? Does the documentation match with the services being billed, or does it fall short? Join Aimee for a hands-on audit of an inpatient E/M service and get an idea of the information and documentation needed to correctly code inpatient E/M services.Feb 8th, 2018
The Proper Way to Report Modifiers
by Find-A-Code™
Modifier 25 has long been a coding conundrum and an auditor's gold mine. Don't risk take-backs, penalties, or accusations of fraud and abuse. Join Aimee in this webinar on how to properly report modifier 25 and have confidence in your code reporting.by Find-A-Code™
Using Find-A-Code's New Evaluation and Management Calculator Toolby Find-A-Code™
Evaluation and Management Self Audit for Beginners, Part 4: Medical Decision Makingby Find-A-Code™
Evaluation and Management Self Audit for Beginners, Part 3: Examinationby Find-A-Code™
Evaluation and Management Self Audit for Beginners, Part 2: Historyby Find-A-Code™
Evaluation and Management Self Audit for Beginners, Part 1: FundamentalsLinks and resources by topic.
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