E/M Documentation and Coding Articles and Resources

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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.

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.

3 Reasons Coders Should Review the ICD-10-CM Codes and Coding Guidelines Annually

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.

Understanding the Changes to the 2023 Evaluation & Management (E/M) Definitions for Chronic Conditions

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.

How Does the Definition of "Problem Assessed" Change in the 2023 E/M Guideline Updates?

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.

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.

Significant Changes to Emergency Department E/M Reporting Coming in 2023

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.

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 ...

2022-05-26-MLNC - Biosimilars: Interchangeable Products May Increase Patient Access

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 - -...

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 ...

How Much Do You Care about the 2022 Care Management Service Changes?

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.

Preventive Medicine Versus E&M Codes: The Same-Day Coding Dilemma

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,...

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...

Minor Procedures Get a Major Sting in the 2021 CERT Report

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.

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.

Split/Shared Visits No Longer Specific to Medicare Plans in 2022

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.

Critical Care Services Changes in the Medicare 2022 Final Rule

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.

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. 

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.

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.
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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.

2023 CPT Evaluation & Management Updates 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Dealing with the Little Coding Conundrums 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Do Minor Procedures Feel like Major Work? 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Reporting Telemedicine Services by Aimee Wilcox 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Split/Shared & Incident-to Evaluation and Management Changes for 2022 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Scoring E/M Services Based on MDM 

by  Wyn Staheli, Director of Content - innoviHealth  and  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

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

Evaluation & Management Coding Rules are Changing in January - Is Your Organization Ready? 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Preparing for E&M Changes in 2021 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

E/M and the Organ Systems Part 2 of 2 

E/M and the Organ Systems Part 2 of 2

E-M and the Organ Systems (Part 1) 

E-M and the Organ Systems (Part 1)

Coding Auditing Evaluation and Management and 2019 

Coding Auditing Evaluation and Management and 2019

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).

Coding Auditing Inpatient Evaluation and Management — A Hands-On Experience 

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.

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.

Using Find-A-Code's New Evaluation and Management Calculator Tool 

by  Find-A-Code™

Using Find-A-Code's New Evaluation and Management Calculator Tool

Evaluation and Management Self Audit for Beginners, Part 4: Medical Decision Making 

by  Find-A-Code™

Evaluation and Management Self Audit for Beginners, Part 4: Medical Decision Making

Evaluation and Management Self Audit for Beginners, Part 3: Examination 

by  Find-A-Code™

Evaluation and Management Self Audit for Beginners, Part 3: Examination

Evaluation and Management Self Audit for Beginners, Part 2: History 

by  Find-A-Code™

Evaluation and Management Self Audit for Beginners, Part 2: History

Evaluation and Management Self Audit for Beginners, Part 1: Fundamentals 

by  Find-A-Code™

Evaluation and Management Self Audit for Beginners, Part 1: Fundamentals

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