Description:

The E/M guidelines have sections that are common to all E/M categories and sections that are category-specific. Most of the categories and many of the subcategories of service have particular guidelines or instructions unique to that category or subcategory. It is essential to review the instructions for each category or subcategory. These guidelines are to be used by the reporting physician or other qualified healthcare professional to select the appropriate level of service. These guidelines do not establish documentation requirements or standards of care. The primary purpose of documentation is to support patient care by current and future healthcare teams. These guidelines are for services that require a face-to-face encounter with the patient and family/caregiver.

There are many code categories in the Evaluation and Management section (99202-99499). Each category has specific guidelines, or the codes include details. These E/M guidelines are written for the following categories:

• Office or Other Outpatient Services
• Hospital Inpatient and Observation Care Services.
• Consultations.
• Emergency Department Services.
• Nursing Facility Services.
• Home or Residence Services.
• Prolonged Service with or without Direct Patient Contact on the Date of an Evaluation and Management Service.

We will review all codes that were modified, deleted, revised, and newly established. Take advantage of this critical 2023 CPT E/M changed code and guidelines webinar, as this information will play a huge role in proper claims coding and documentation. It will affect revenue, if applied after 1.1.2023, to all providers who perform services for hospital inpatient and observation care; consultations in office, emergency department, and inpatient locations; nursing facility and residence services; and prolonged visits.

Areas Covered:

• Review deleted codes for Hospital Observation services.
• Review revised codes for Hospital Inpatient and Observation care services guidelines.
• Review deleted Consultation codes.
• Review revised Emergency Department services codes and guidelines.
• Review deleted codes for Nursing facility services.
• Review revised codes for nursing facility services and guidelines.
• Review deleted Domiciliary, Rest home, or custodial care services codes.
• Review deleted codes for Home or Residence services.
• Review revised codes for Home or Residence services and guidelines.
• Review of deleted codes for Prolonged services.
• Review of revised codes for Prolonged services and guidelines.
• Review examples referenced in the American Medical Association document on CPT Evaluation and Management (E/M) Code and Guideline Changes.

Webinar Highlights:

• Counseling and educating the patient/family/caregiver.
• Obtaining and reviewing separately obtained history.
• Performing a medically appropriate examination and evaluation.
• Preparing to see the patient.
• Ordering medications, tests, and procedures.
• Referring and communicating with other healthcare professionals.
• Documenting clinical information in the electronic or other health record.
• Independently interpreting results and communicating results to the patient/family/caregiver.

Why Should You Attend:

Following a significant update to office and outpatient evaluation and management (E/M) guidelines and reporting in 2021, the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) made similar changes to other E/M categories in 2023. Understanding these changes is essential because E/M services are standard for many healthcare organizations and play a key role in financial health and compliance programs.

The basic format of codes with levels of E/M services based on medical decision-making (MDM) or time is the same. First, a unique code number is listed. Second, the place and type of service are specified (e.g., office or another outpatient visit). Third, the content of the service is defined. Fourth, time is limited. (A detailed discussion of time is provided in the Guidelines for Selecting Level of Service Based on Time).

Who Should Attend:

• Medical providers
• Practice managers
• Medical practice owners
• C-level executives
• Medical billers
• Medical coders

Presenter Information:

Name: Kate Gilman

Kate has almost two decades of experience in the healthcare industry. She is an expert coder, and compliance officer, and trains healthcare providers all over the country. Kate utilizes her expertise to uncover ways to improve billing and coding inefficiencies, training staff, and ensure compliance while achieving maximum results and revenues for her clients.

Kate’s successes include small and large practices, ranging from primary care to specialists and surgeons. She is known for helping providers feel confident in their coding and have peace of mind with their compliance practices.

Kate’s acute attention to detail, deep understanding of coding and billing, and proactive approach make her an indispensable asset to all her clients.