1. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 5-1 Chapter 5 Evaluation and Management Codes, Part 2

2. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Objectives 5.1 Apply the guidelines for coding different types of evaluation and management services. 5.2 Correctly assign preventive medicine codes as appropriate. 5.3 Determine the most accurate long-term care service codes. 5-2

3. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Objectives (cont.) 5.4 Abstract the physician’s notes to determine the correct nursing facility service code. 5.5 Calculate the correct code or codes for critical care services. 5.6 Apply evaluation and management modifiers correctly. 5-3

4. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms Anticipatory guidance Basic personal services Care plan oversight services Critical care services Global surgery package 5-4

5. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms (cont.) Hospice Interval Nursing home Preventive Risk factor reduction intervention 5-5

6. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Preventive Medicine Preventive care - also known as an annual physical. Comprehensive preventive medical examinations include: –Counseling –Anticipatory guidance –Risk factor reduction interventions 5-6

7. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Preventive Medicine (cont.) Counseling –General discussion of high-risk conditions in addition to preventive visit. Anticipatory guidance –Suggest actions when a patient is at high risk for a condition. Risk factor reduction interventions –Active intervention (prescribing medicine or a specific diet) to combat high-risk conditions. 5-7

8. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Counseling and/or Risk Factor Reduction Intervention Outside of preventive visit to educate patient on better health practices. Codes 99401–99404,99411–99412,99420– 99429. 5-8

9. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 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. 5-9

10. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Long-Term Care Facilities –Skilled nursing facilities (SNF) –Intermediate care facilities (ICF) –Long-term care facilities (LTCF) –Psychiatric residential treatment centers 5-10

11. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Long-Term Care Facilities (cont.) –Assisted living facilities –Domiciliaries –Rest homes –Custodial care settings –Alzheimer’s facilities 5-11

12. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Care Plan Oversight Services Determined by length of time and type of facility. 99339–99340 for patients in assisted living or domiciliary facilities. 99374–99375 for home health care patients. 99377–99378 for hospice patients. 5-12

13. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Critical Care Codes Critically ill or injured patients have a high likelihood of a deteriorating life-threatening condition. Code is determined by physician’s time and specific services provided. Patient does not have to be in a designated critical care unit. 5-13

14. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Case Management Services Health care professionals working together to serve a patient with several or complex health issues. Codes include: –Anticoagulant management –Medical team conferences –Telephone services –Online medical evaluation 5-14

15. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. E/M in the Global Surgical Package Visit immediately prior to procedure Immediate post-operative care (while patient is in recovery) Postoperative visits in the office within the global period covered: These follow-up visits are not reported with usual office or hospital E/M codes. Instead report: 99024 Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management services was performed during a postoperative period for a reason(s) related to the original procedure. 5-15

16. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Modifiers Used with E/M Codes –24 Unrelated evaluation and management service by the same physician during a postoperative period –25 Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure of other service. –32 Mandated service –57 Decision for surgery 1-16

17. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Newborn and Pediatric Evaluation and Management Care Newborn Care Services: 99460–99463 A physician will evaluate a neonate as part of routine health care procedures. Location: –Hospital –Birthing center –Other location 5-17

18. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Intensive Care Services - Neonatal & Pediatrics Include: –Intensive observation –Cardiac and respiratory monitoring –Vital sign monitoring 5-18

19. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Special Evaluation Services An attending physician may need to evaluate a patient for a certificate of disability. No actual treatment or management of the patient’s condition is provided. 5-19

20. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Complex Chronic Care Coordination Services E/M codes focus on support services and management of care provided. Services are provided to patients who: –are at significant risk –require moderate or highly complex medical decision making during treatment Health care professionals must implement a documented care plan to coordinate multiple disciplines. 5-20

21. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Transitional Care Management Services Codes and requirements for transfers: –Communication –Medical decision making of high complexity during the service period –Face-to-face visit 5-21

22. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chapter Summary Your job as a professional coding specialist is to understand the variety of essentials involved in coding E/M services properly and to report those services accurately. 5-22