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1、Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text s
2、tyles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to
3、 edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Se
4、cond level,Third level,Fourth level,Fifth level,*,*,Moving Targets:Coding Advice To Take You From The Complex To The Simple,T.Brian Callister,M.D.,F.H.M.,National Medical Director,LifeCare Hospitals,President-Elect,Nevada State Medical Association,Nevada State Chair,AMA-OMSS,Chairman,ALTHA Clinical
5、Committee,Associate Professor,University of Nevada,Objectives:,At the end of the lecture,the attendee will be able to:,Understand how the recent coding changes effect your practice,Describe how to appropriately code for consultative services,List the documentation requirements for billing from the s
6、imple to the highly complex,Identify techniques for appropriately maximizing reimbursement,Summarize the changes necessary to convert specialty codes to new patient or follow up codes for inpatient,outpatient,nursing home,and observation levels of service,WAIVER:,This presentation is informational o
7、nly and may not be used in differences of opinion or disputes with CMS,insurance carriers,or any other party.No implied or expressed warranty regarding this content is made,and you are urged to consult the constantly changing regulations,laws,and policies regarding coding on a regular basis.,Coding“
8、101,If You Get It,They Will Change It,ICD-9 and ICD-10,E/M and CPT,Maximizing Reimbursement,CMS Fraud and Abuse,Coding“101,If You Get It,They Will Change It,Evaluation and Management Defined,Current Procedural Terminology,Medicare Physician Fee Schedule,Recovery Audits,The Nature of E/M Services:,Th
9、e ICD-9 and CPT Relationship,ICD-9 codes explain,WHY,the service was performed,CPT codes explain,WHAT,service was performed,Diagnosis codes must support the CPT code(s)assigned,The Nature of E/M Services:,Medical Necessity,Patients presenting problem or reason for the visit,Level of service IS medic
10、ally reasonable AND necessary,Demonstrated IN the documentation,not,by the,amount,of documentation,Must be supported by ICD-9 diagnosis,The Nature of E/M Services:,Evaluation and Management Defined,“Face to Face Services,“Visit Examination,Evaluation,and Delivery of Care,Interaction and Independent
11、Judgment,Documentation,The Nature of E/M Services:,Evaluation and Management Components,History*,Examination*,Medical Decision Making*,Counseling,Coordination of Care,Nature of Presenting Problem,Time,*Key Component,The Nature of E/M Services:,Evaluation and Management Components,Concurrent Care,Sim
12、ilar services,same day,Unit/Floor Time,Observation,inpatient,nursing home,Includes chart,exam,writing notes,discussion with family and/or other professionals,Medical Decision Making:,CMS and CPT Descriptions,Elements,Number of diagnoses&management options,Amount of data reviewed and orders,Level of
13、risk of complications/morbidity/mortality,Levels,Straightforward,Low,Moderate,High,To qualify for a given type of decision-making,two of the three elements must be met or exceeded,12,Complexity of Medical Decision-Making(MDM),A,Number of diagnoses and/or management options,1 Minimal,2 Limited,3 Mult
14、iple,4 Extensive,B,Amount and complexity of data reviewed or ordered,1 None/Minimal,2 Limited,3 Multiple,4 Extensive,C,Risk of complications for morbidity and/or mortality,Minimal,Low,Moderate,High,Type of medical decision-making,Final MDM requires that,2 of 3 of the above components are met or exce
15、eded,Straight Forward,(S),Low,Complexity,(L),Moderate,Complexity,(M),High,Complexity,(H),Leveling Medical Decision-Making,EVALUATION AND MANAGEMENT(E&M)LEVEL OF SERVICE,E&M Code,History,Exam,MDM,Average Time,E&M Code,History,Exam,MDM,Average Time,New,Patient Office/Outpatient,Requires 3 of 3 compone
16、nts met,Established,Office/Outpatient Visit,-,Requires 2 of 3 components met.MDM must be 1 of the 2 required components met,99201,PF,PF,S,10,99211,N/A,N/A,N/A,5,99202,EPF,EPF,S,20,99212,PF,PF,S,10,99203,D,D,L,30,99213,EPF,EPF,L,15,99204,C,C,M,45,99214,D,D,M,25,99205,C,C,H,60,99215,C,C,H,40,13,Overall Leveling,Consultations,CMS“inactivated consultation codes,Office Consultations:99241-99245,Inpatient Consultations:99251-99255,Exception:“telehealth initial G0425-7,Outpatient Consultations,New pati
甘肅省高等學校研究生導師科研項目
