Chapter 15 Antiparasitics Copyright © 2011 Delmar, Cengage Learning.
© 2010 Delmar, Cengage Learning Chapter 9 CPT Evaluation and Management.
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Transcript of © 2010 Delmar, Cengage Learning Chapter 9 CPT Evaluation and Management.
© 2010 Delmar, Cengage Learning
Chapter 9
CPT Evaluationand Management
© 2010 Delmar, Cengage Learning
E/M Section
• Codes 99201–99499• First section in CPT• Review guidelines at beginning section
• Apply applicable notes
© 2010 Delmar, Cengage Learning
E/M Coding Tips
• Notes located beneath headings and/or subheadings apply to all codes in heading or subheading
• Parenthetical notes located below a specific code apply to that code only– Unless the note indicates otherwise
© 2010 Delmar, Cengage Learning
E/M Overview
• Introduced in 1992• Between three and five levels of service
• Reflects amount of work involved in providing health care to a patient
© 2010 Delmar, Cengage Learning
Levels of Service
• Organized according to:– Place of service
• Physical location where health care is provided to patients (e.g., office, hospital, home, nursing facility)
– Type of service• Type of health care services provided to patients (e.g., new or initial encounter, follow-up or subsequent encounter, consultation)
© 2010 Delmar, Cengage Learning
Example
• Dr. Miller completed Jennifer Sullivan’s history and physical on the first day of her inpatient admission– Place of service: hospital– Type of service: initial care– E/M category: hospital inpatient services
– E/M subcategory: initial hospital care
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E/M Section Guidelines
• Located at beginning of section
• Includes:– Classification of E/M services– Definitions of commonly used terms– Unlisted service– Special report– Clinical examples– Instructions for selecting level of E/M service
© 2010 Delmar, Cengage Learning
Classification of E/M
• Categories (e.g., office, outpatient visits, consultations)
• Subcategories (e.g., new and established patients)
• Five-digit numerical codes (99201–99499)
(continued)
© 2010 Delmar, Cengage Learning
Classification of E/M
• Code descriptions include:– Place and/or type of service– Content of service– Detailed history and examination– Nature of presenting problem– Time required to provide service
© 2010 Delmar, Cengage Learning
E/M Key Terms
• New patient• Established patient• Concurrent care• Unlisted service• Special report• Clinical examples (Appendix C)
© 2010 Delmar, Cengage Learning
Levels of E/M Service
• When selecting, require key components of history, examination, and medical decision making
• Contributory components include counseling, coordination of care, nature of presenting problem, and time
© 2010 Delmar, Cengage Learning
Key Components
• Three components:– Extent of history– Extent of examination– Complexity of medical decision making
• New patients– Three components required
• Established patients– Two of three components required
© 2010 Delmar, Cengage Learning
Extent of History
• Includes:– History of present illness (HPI)– Review of systems (ROS)– Past/Family/Social history (PFSH)
• Four types:– Problem-focused– Expanded problem-focused– Detailed– Comprehensive
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Extent of Examination
• Four types:– Problem-focused– Expanded problem-focused– Detailed– Comprehensive
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Complexity of Medical Decision Making
• Measured by:– Number of diagnoses or management options
– Amount and/or complexity of data– Risk of complications and/or morbidity or mortality
(continued)
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Complexity of Medical Decision Making
• Documentation includes:– Ancillary test results (e.g., laboratory)
– Known diagnoses– Opinions of other physicians– Planned course of action– Review of previous records
© 2010 Delmar, Cengage Learning
Medical Decision Making
• Four types of complexity:– Straightforward– Low– Moderate– High
© 2010 Delmar, Cengage Learning
E/M Code Selection
Select E/M code based on extent of history and examinationand complexity of medical decision making
History Problem-focused
Expandedproblem-focused
Expanded problem-focused
Detailed Compre-hensive
Examina-tion
Problem-focused
Expandedproblem-focused
Expanded problem-focused
Detailed Compre-hensive
MedicalDecisionMaking
Straight-forward
Lowcomplexity
Moderate complexity
Moderate Complexity
High Complexity
Go to appropriate E/M category/subcategory andselect code based on this information
Current Procedural Terminology © 2008 American Medical Association. All rights reserved.
© 2010 Delmar, Cengage Learning
Contributory Components
• Counseling and/or coordination of care components “drive” CPT code selection only when they dominate the encounter.
© 2010 Delmar, Cengage Learning
Counseling
• Diagnostic results• Prognosis• Risks and benefits of treatment options
• Instructions for treatment and/or follow-up
• Compliance with treatment options• Risk factor reduction• Patient and family education
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Nature of the Presenting Problem
• Five types:– Minimal– Self-limited or minor– Low severity– Moderate severity– High severity
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Time
• Face-to-face time– Amount of time office or outpatient care provider spends with patient and/or family
• Unit/Floor time– Amount of time provider spends at patient’s bedside and managing patient’s care on unit/floor
© 2010 Delmar, Cengage Learning
Billing According to Length of Time
• Document:– Total length of time for the encounter
– Length of time spent coordinating and/or counseling
– Issues discussed – Relevant history, exam, and medical decision making
© 2010 Delmar, Cengage Learning
Code 99211
• Nurse visit• Reported when ancillary personnel provide E/M services
• Document chief complaint and description of service provided
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Hospital Observation Services
• Subcategories– Observation care discharge services– Initial observation care
• Discharge services– Final examination of patient– Discussion of hospital stay– Instructions for continuing care
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Initial Observation Care
• Reported for patients who are admitted for observation services on one date and discharged from observation status on a different date
© 2010 Delmar, Cengage Learning
Hospital Inpatient Services
• Subcategories– Initial hospital care– Subsequent hospital care– Observation or inpatient care services
– Hospital discharge services
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Hospital Discharge Services
• Includes:– Final examination of patient– Discussion of hospital stay – Instructions for continuing care– Preparation of discharge records, prescriptions, and referral forms
© 2010 Delmar, Cengage Learning
Consultations
• Consultation criteria• Subcategories
– Office or other outpatient services– Initial inpatient consultations
• Preoperative clearance
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Pediatric Critical Care Patient Transport
• Definition• Interfacility transport• Critical illness or injury
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Critical Care Services
• Physician directly delivers medical care to critically ill or injured patient– Manages life-threatening conditions– Single or multiple vital organ system failure
• Does not have to be provided in a critical care unit
• May be continuous or interrupted
(continued)
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Critical Care Services
• Includes the following procedures:– Blood gases– Chest x-rays– Gastric intubation– Information data stored in computers– Cardiac output measurements– Pulse oximetry
(continued)
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Critical Care Services
• Includes the following procedures:– Temporary transcutaneous pacing– Vascular access procedures– Ventilatory management
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Inpatient Neonatal and Pediatric Critical Care
• Neonate• Low birth weight
– Less than 1500 grams (g)
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Nursing Facility Services
• Includes:– Nursing facility (NF)– Skilled nursing facility (SNF)– Intermediate care facility (ICF)/Mentally retarded
– Long-term care facility (LTCF)– Psychiatric residential treatment facility
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Prolonged Services
• Reported in addition to an E/M service at any level
• Physician’s services involving patient contact that are considered beyond the usual service in either an inpatient or outpatient setting
(continued)
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Prolonged Services
• Reported only when time is greater than 30 minutes
• Time must be documented
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Physician Standby Services
• Physician spending a prolonged period of time without patient contact waiting for an event to occur that will require the physician’s services
(continued)
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Physician Standby Services
• Standby types:– Operative– Pathology– Diagnostics– Obstetrics– Pediatrics
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Case Management Services
• Physician is responsible for:– Direct care of patient– Coordinating and controlling access to or initiating and/or supervising other health care services needed
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Care Plan Oversight Services
• Cover physician’s time while supervising a complex and multidisciplinary care treatment program for a specific patient under the care of a home health agency, hospice, or nursing facility
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Preventive Medicine Services
• Routine examinations or risk management counseling for children and adults who exhibit no overt signs or symptoms of a disorder while presenting to the medical office for a preventive medical physical
• Wellness visits• Risk factors
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Newborn Care
• Service provided in a variety of health care settings, hospitals, birthing centers, and homes that include:– History and examination of normal infant
– Attendance at delivery and initial stabilization of newborn
– Newborn resuscitation
© 2010 Delmar, Cengage Learning
Counseling Risk Factor Reduction
• Preventive Medicine Counseling (99401-99404)
• Used for promoting health and preventing illness and injury
(continued)
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Counseling Risk Factor Reduction
• Intervention should address family problems, diet and exercise, substance use, injury prevention, and dental health
• No illness should be present with these codes
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Behavior Change Intervention
• Behavior Change Intervention (99406-99409)
• For patients who have behavior that is considered an illness, itself
• Smoking and tobacco cessation• Alcohol and/or substance abuse
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Non-Face-to-Face Physician Service
• Telephone Service (99441-99443)
• E/M service provided by a physician using the telephone
(continued)
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Non-Face-to-Face Physician Service
• Code is not reported if service ends with decision to see patient within 24 hours or within seven days of a previously completed procedure
• Provided to an established patient
© 2010 Delmar, Cengage Learning
Special E/M Services
• Provided to:– Establish baseline information prior to issuance of life or disability insurance certificates
– Examine a patient with a work-related or medical disability problem