1. The Complete Procedure Coding Book By Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA Chapter 5 Evaluation & Management Codes Part 2 Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved McGraw Hill/Irwin

2. Learning Outcomes Apply the guidelines for coding different types of E/M services. Correctly assign preventive medicine codes, as appropriate. Determine the most accurate long-term care service codes. 5 - 2

3. Learning Outcomes Abstract the physician’s notes to determine the correct nursing facility service code. Calculate the correct code or codes for critical care services. Apply E/M modifiers correctly. 5 - 3

4. Introduction This chapter will review sub- categories of E/M codes, including preventive medicine assessments, evaluations of nursing home patients, counseling, and others. 5 - 4

5. Preventive Medicine Also known as an annual physical Determined by: –New or established patient –Age of patient being examined 5 - 5

6. Counseling Rick factor reduction intervention -- when provided at a separate encounter from the annual physical Examples : nutritional counseling or smoking cessation Code from 99401 - 99404, 99411 - 99412, or 99420 - 99429 5 - 6

7. Home Services Codes 99341 - 99350 may ONLY be used when the physician conducts the visit. When a health care professional, other than a physician, sees a patient at home, use codes 99500 – 99602. 5 - 7

8. Long-Term Care Services Understand the differences in types of facilities: –Nursing home is different than an assisted-living facility –Determined by the types of services provided day-to-day for the patient 5 - 8

9. Nursing Facility Admission services are coded differently than Subsequent nursing facility care. Patient history can be interval. Case plan oversight services are coded separately. 5 - 9

10. Critical Care Patient must have a life- threatening condition, expected to worsen Separate codes for neonatal, pediatric, and adult critical care Code determined by total length of time spent during one day 5 - 10

11. Case Management Services Medical conferences with other health care professionals –Interdisciplinary team Telephone calls –Patient or family member –Coordinating care with other professionals 5 - 11

12. E/M Modifiers 21 Prolonged E/M 24 Unrelated E/M during post-operative period 25 Separate E/M on same day as procedure or other service 32 Mandated services 57 Decision for surgery 5 - 12

13. Newborn E/M A physician will evaluate a neonate as part of routine health care procedures. Use codes 99431 - 99440 When continuing care is provided afterward, code visit as established patient 5 - 13

14. Special Evaluations An attending physician may need to evaluate a patient for a certificate of disability. Examples : Confirm medical necessity for a wheelchair or to gain disability income. 5 - 14

15. Chapter Summary Your job, as a coding specialist, is to understand the variety of essentials involved in coding E/M services properly and to report those services accurately. 5 - 15