Preventive Services and E/M Coding Requirements – Some Helpful Tips
Many of the preventive service codes that have been introduced by the CMS over the past two years have time requirements, so it is important to document the time spent on these services.
Published on: Mar 4, 2016
Transcripts - Preventive Services and E/M Coding Requirements – Some Helpful Tips
Preventive Services and E/M Coding Requirements – Some Helpful TipsMany of the preventive service codes that have been introduced by the CMS over the pasttwo years have time requirements, so it is important to document the time spent on theseservices.Many of the preventive service codes thathave been introduced by the CMS over thepast two years have time requirements, soit is important to document the time spenton these services. Remember that whenreporting preventive services on the sameday as an E/M service, you need to attachthe appropriate modifier to avoidoverlapping of the services. Modifier 59has to be appended for a distinctprocedural service and Modifier 25 for a significant, separately identifiable E/M serviceby the same physician on the same day of the procedure or other service. It is importantto record that you performed both procedures separately and that they were medicallynecessary. • There are certain time-based preventive service codes such as that for behavior therapy to reduce cardiovascular risk (G0446) that do not require documentation of time spent. However, it is best to make a record of the time spent for such services also, because in case of an audit, you will have to justify the use of this code. 1
• The Medicare eligibility screen usually doesn’t notify providers when an annual screening has taken place. However, you will be given information about the next suitable date when the service can be performed.Medical Decision Making Made Simple for E/MTo arrive at the correct level of Medical Decision Making (MDM) points have to beassigned to each of the three components the physician performs. According to SuzanBerman, CPC, CEMC, CEDC, Senior Director of Physician Services at HealthcareRevenue Assurance Associates based out of Plantation, Florida, the three componentsthat add complexity to the physician’s decision making process are“diagnoses/management options, complexity of data reviewed/ordered, and the table ofrisk.” Two out of these three components have to score at a particular level in order toassign that level of MDM. The MDM score is ‘moderate’ if the number of diagnoses islow but the complexity and amount of data as well as the level of risk are both moderate.Another way to arrive at the correct level of MDM is to eliminate the lowest and highestscores; the remaining score will be the MDM level. • Have a clear idea of each level of diagnosis and for each diagnosis assign a point. For a self limited/minor problem you can assign one point each, up to a maximum of two points. For an established problem, improving/stable assign one point each. If the problem is established/worsening assign 2 points each; if the problem is a new one with no planned additional workup, assign 3 points each up to a maximum of 3 points; for a new problem, additional workup assign four points each. • Consider the amount and complexity of the medical encounter data. The complexity has to be scored in the same manner as the diagnoses, i.e. minimal (0- 1); low/limited (2); moderate (3); and high (4+) 2
• The level of risk is difficult to determine. It comprises three subcategories. These are presenting problem, diagnostic procedures ordered and management options. The patient’s risk level is determined as minimal, low, moderate or high based on the highest score from only one of the three categories, not from each category.For More Information:OutSource Strategies InternationalUnited States Main Office8596 E. 101st Street, Suite HTulsa, OK 74133Phone 800-670-2809http://www.outsourcestrategies.com 3