Evaluation management billing codes

The Current Procedural Terminology Evaluation and Management Codes. These codes were introduced into the system in 1992 so they are only 17 years old. Yes that is correct, 17 years of insanity. Which is why the whole field has only gotten even more bloated lately.....

Prior to the E and M codes "visit" codes were used. Which obviously made a lot more sense to physicians who usually had their day scheduled as such with types of visits as comprehensive physicals and brief check ups.....

But, to dismantle the system we need to do it systematically. That is, by finding out what these codes mean and then applying them appropriately.

The next 5 days will be spent on the new patient E and M codes.

We start off the 9920x series with 99201. Office or outpatient visit for the new patient.

99201 requires 3 things.
1. A focused Problem History
2. A problem focused exam
3. Straight forward Medical Decision Making (This is the little bastard that gets us all)

As physicians, I think we need a good understanding and the best way to do that is with a clinical example of a 99201.....so here you go.

Initial visit for a 24 year old here for a refill of her acne cream.

These insurers are assuming you are doing the following things for this patient and it would be wise to document these as well as the mandatories.

1. Preservice-review the medical history form that the patient filled out while in the waiting room
2. Intraservice-Problem focused exam-in this case the skin, Formulate a treatment plan, discuss this with the patient. Also, discuss the need for preventative health maint....Reconcile medications and write an Rx as needed
3. Postservice-Complete the medical documentation, handle treatment failure if that happens, provide care coordination......

Pretty simple huh? How many people bill this one as a 99202???? I bet a ton of you do. But you will soon see that the cost of an audit is more than the extra few bucks you might get for jumping from a 1 to a 2....

source 25modifier.blgospot.com

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