149x Filetype PDF File size 2.21 MB Source: www.iephysicians.com
Emergency Medicine Documentation Review 2020 Documentation Provides • Proof of the delivery of quality patient care • Better protection medico-legally • Ability to ensure accurate billing and reimbursement through practices that comply will all laws, rules and regulatory guidelines • Communication with colleagues. 2 EM DOCUMENTATION GUIDELINES -CPT & CMS E & M Nature of CPT CMS RVU Presenting Nomenclature Quantification 2020 Problem 99281 Minor; Problemfocused Hx 1 HPI- 0 ROS- O PFS Hx 0.64 self limited Problem focused Exam 1 Organ system exam Straightforward MDM Straightforward MDM 99282 Low Expanded problem focused Hx 1HPI-1 ROS-0 PFS Hx 1.23 Expanded problem focused Ex 2 Organ system exam Low Complexity MDM Low Complexity MDM 99283 Moderate Expanded problemfocused Hx 1HPI-1 ROS-0 PFS Hx 1.84 Expanded problem focused Ex 2 Organ system exam Moderate Complexity MDM Moderate Complexity MDM 99284 High Detailed Hx 4 HPI- 2 ROS- 1 PFS Hx 3.38 Detailed Exam 2+ Organ System Exam Moderate Complexity MDM Moderate Complexity MDM 99285 High Comprehensive Hx 4 HPI- 10 ROS- 2 PFS Hx 4.91 ComprehensiveExam 8 organ systemexam High Complexity MDM High Complexity MDM 3 Determine the Extent of H & P •Medical Necessity of a service is the overarching criteria for payment in addition to the individual requirements of a CPT Code “Medical necessity is defined as accepted health care services and supplies provided by health care entities, appropriate to the evaluation and treatment of a disease, condition, illness or injury and consistent with the applicable standard of care.” “Medicare Claims Processing Manual Chapter 12, Section 30.6.1” 4
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