E/M Highlights and New Medicare Rules for Critical Care and Shared Services


*agenda subject to change

1:00pM — 2:30pM

Office and Inpatient E/M

  • Categories of E/M: Outpatient and Inpatient
  • Outpatient E/M coding and Documentation: Using Medical Decision Making or Time to Determine Level of Service
  • Using Time or Medical Decision in the Outpatient setting: Dealing with interpretation and other issues
  • Interpreting the Elements in Medical Decision Making
  • Element #1: Number and Complexity of Problems Addressed
    • Do more problems mean a higher level of E/M?
    • Differentiating between exacerbation and severe exacerbation
    • Documenting problem severity
  • Element #2 Data to be Reviewed and Analyzed
    • Order and review, can both be “counted”?
    • When can interpretation of results be counted?
    • External notes, when do they count and can more than one be counted?
  • Element #3 Risk of Complications and/or Morbidity or Mortality of Patient Management
    • Defining level of Risk: what does CPT say?
    • Documenting level of Risk. Do the current Risk table examples still apply?
    • How do test and treatment decisions impact co-morbidity and risk?

Inpatient and Outpatient Consultation Coding: Using History, Exam and Medical Decision Making to Determine Level  

  • Inpatient E/M Guidelines
  • Levels of E/M Codes (History, Examination, Medical Decision Making) 

2:30pM — 2:45pM


2:45pM — 3:45pM

Medicare’s Revised Guidelines for Split Shared Billing NEW!

  • In the facility (ED, observation, inpatient)
  • In the office/clinic
  • What about provider-based clinic?
  • Applying modifier FS

3:45pM — 5:00PM

Critical Care Coding Changes NEW!

  • Medicare changes to Critical Care Guidelines
    • Billing during the global period. How is modifier FT used?
    • Billing split/shared in critical care; how does this work?
    • Audits and Critical Care

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Coding Coaches