All CPT codes trademarked by the American Medical Association. All rights reserved. CARRIERS may differ on E&M auditing criteria--see TRAILBLAZER. This should not be the only source used for coding and billing. All coding and billing decisions should be made on a case-by-case basis based upon documentation and insurance guidelines. All information contained herein is valid for the date of this seminar only. This presentation is based on national guidelines. Some E/M guidelines are very subjective and decisions about levels can be up to an individual auditor. This presentation is a summary only. For Medicare regulations, see your local Medicare web site.

Source: CMS E/M Documentation Guidelines

Dx./mgt. options Amount of data Overall riskMinimalLowModerateHigh Level of MDM Straightforward Low Moderate High Two of the three areas: Dx. Options, Amount of Data, and Risk Establish the MDM Level

Amount and/or Complexity of data reviewed Points are assigned to each section below based on the number of data items reviewed max = 4 pts PointsTotal Review and/or order of clinical labs11 Review and/or order of tests radiologic study, other non invasive diagnostic study 1 Discussion of diagnostic study w/interpreting MD1 Decision to obtain old records and/or obtaining history from someone other than the patient 1 Review and summarization of old records or gathering data from source other than patient 2 Independent visualization of image, tracing or specimen itself 2 2 Total Points 3

Key Factors 2 of 3 Level 5Level 4Level 3 History HPI ROS PFSH of of 3 1 NA EXAM≥ 8 organ systems a) An extended exam of affected area or b) 12 bullets (1997) a) Limited exam of affected and related system or b) 6 bullets (1997) MDM (2 of 3) Dx/Tx Options Data Risk High Complexity Extensive High Moderate Multiple Moderate Low Complexity Limited Low

Key Factors 3 of 3 Level 5Level 4Level 3 History HPI ROS PFSH 4 10 All Three 4 10 All Three of 3 EXAM≥ 8 organ systems a) An extended exam of affected area or b) 12 bullets (1997) MDM (2 of 3) Dx/Tx Options Data Risk High Complexity Extensive High Moderate Multiple Moderate Low Complexity Limited Low

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Service Performed CPT Code Documentation required History/Exam/MDM Problem SeverityMedicare Consult level (15 min) PF/PF/Straightforward Self limited or minor (10 min) Consult level (30 min) EPF/EPF/Straightforward Low severity (20 min) Consult level (40 min) Detailed/Detailed/Low Moderate severity (30 min) Consult level (60 min) Comp./Comp./Moderate Moderate to high severity (45 min) Consult level (80 min) Comp./Comp./High Moderate to high severity (60 min) 54

Service Performed CPT CodeDocumentation required (All 3 to 2 out of 3) History/Exam/MDM Problem SeverityMedicare Consult level (15 min) PF/PF/StraightforwardSelf limited or minor99212 (10 min) Consult level (30 min) EPF/EPF/Straightforward or Low for Low severity99213 (15 min) Consult level (40 min) Detailed/Detailed/Low or Moderate for Moderate severity99213 or (15-25 min) Consult level (60 min) Comp./Comp./Moderate or High for Moderate to high severity99214 or (25-40 min) Consult level (80 min) Comp./Comp./HighModerate to high severity99215 (40 min) 55

CPT CodeHistoryExamMDM Traditional Medicare (20 min) PF HxPF ExamSF MDM (40 min) EPF HXEPF ExamSF MDM (55 min) Det HxDet ExamLow MDM99221 (30 min) (80 min) Comp HxComp ExamModerate MDM99222 (50 min) (110 min) Comp HxComp ExamHigh MDM99223 (70 min) 56

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58 Consult CodeMaps toPercentage Mapped 2010 Price ($48.69) % $38.95 $ ($91.61) % $67.44 $ ($125.15) % $97.74 $ ($185.38) 992o % $ $ ($226.50) % $ $ Source: CMS Website from Frank Cohen; 2010 NF RVUs; 2009 CF and GPCIs =1

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o PEER REVIEW! Physicians should use forms or software to audit their partners’ E&M. This works in two ways-- improves understanding and brings pressure to change. Read the E&M guidelines EVERY SIX MONTHS. Read PRACTICAL E/M by Stephen Levinson. Use templates, forms, and EMR algorithms wisely.