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The 99000 E&M Codes. Using Dr. Quack’s Score Sheet to understand the Evaluation & Management Codes The updated score sheet can be found on pages 11 and 12 of http://nebraska.aoa.org/documents/ne/2010-05-3RD-PARTY-NEWLSETTER.pdf. The 99000 E&M Codes.
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The 99000 E&M Codes • Using Dr. Quack’s Score Sheet to understand the Evaluation & Management Codes • The updated score sheet can be found on pages 11 and 12 of http://nebraska.aoa.org/documents/ne/2010-05-3RD-PARTY-NEWLSETTER.pdf
The 99000 E&M Codes • The Quack score sheet we are using today can be found on pages 11 and 12 of http://nebraska.aoa.org/documents/ne/2010-05-3RD-PARTY-NEWLSETTER.pdf • The score sheet has been updated from the hard copy mailed in early May…there was an omission in the history section (We can work around it today, however).
The 99000 E&M Codes • E&M coding is based on 3 key components: • History (There are 4 levels of complexity) • Examination (4 levels) • Decision Making (4 levels) • First, the level of complexity of each of these components is determined. • Then the final level of service is determined, based on those levels of complexity.
The 99000 E&M Codes • Levels of service are scored differently for New vs. Established patients. For New Patients, the complexity of the • History, • Exam, and • Decision making …must all three be considered.
The 99000 E&M Codes • For Established patients, only two of the three key components must be considered. • However, it is best to ALWAYS consider Decision Making. • THE RESULTING CODE MUST BE REASONABLE AND NECESSARY. The Decision Making Score helps assure that is the case.
Key Component #1: History • Made up of • Chief Complaint • History of Present Illness (HPI) • Review of Systems (ROS) • Past, Family, & Social History (PFSH)
http://nebraska.aoa.org/documents/ne/2010-05-3RD-PARTY-NEWLSETTER.pdfhttp://nebraska.aoa.org/documents/ne/2010-05-3RD-PARTY-NEWLSETTER.pdf Link on slides 1 & 4
History of Present Illness • Made up of • Location[example: “od”, “os”, “ou”, “upper”…] • Quality [“sharp”, “dull”, “stabbing”...] • Severity[“mild”, “severe”….] • Duration[“short”, “constant”, “hour or so”…] • Timing[“morning”, “nighttime”...] • Context[“driving”, “reading”…] • ModifyingFactors[“bright light”, “when tired”…] • AssociatedSigns & Symptoms[“headache”…] • OR ThreeChronic or inactive conditions • 1.____________[AMD…] • 2.____________[Cataract…] • 3.____________ [EBMD…]
Review of Systems • Made up of • Constitutional (weight loss, etc.) • Eyes • Ears, Nose, Mouth, Throat • Cardiovascular • Gastrointestinal • Genitourinary • Integumentary (skin, breast) • Musculo-skeletal • Neurological • Hematologic Lymphatic • Respiratory • Endocrine • Allergic Immunologic • Psychiatric • All others negative (= 9)
http://nebraska.aoa.org/documents/ne/2010-05-3RD-PARTY-NEWLSETTER.pdfhttp://nebraska.aoa.org/documents/ne/2010-05-3RD-PARTY-NEWLSETTER.pdf
Key Component #2: Examination • Made up of • Acuity • Adnexae, lids, lacrimal sys, pre-auriclar nodes • Cornea • IOT • Confrontation Fields • Conjunctiva, bulbar & palpebral • A/C • Retina, vessels, exudates, hemorrhages (dilated) • Ocular Motility • Pupil/Iris, APD • Lens • Disc, Cup, NFL (dilated) • Systemic elements that briefly assess mental status or general constitution • Oriented to time/location & mood • General Constitution
Key Component #3:Decision Making • Made up of • Diagnosis and Management Options • Data Complexity • Risk • Very Important: Can be used to determine whether the ultimate level of service is truly “REASONABLE AND NECESSARY”
Am I Going to Need to Use One of These Forms For Every 99000 Exam? • Nope. Once you’ve done a number of them, you’ll know intuitively what to bill on almost all of the more common diagnoses. • Keep the forms available for the unusual situations, however. • Now, for some examples………….
Example Case #1 24 YOWM scratched R eye with branch while mowing this morning; blurred vision, mild, scratchy red eye..
24 yowm scratched R eye with branch while mowing this morning; blurred vision, mild, scratchy red eye..
mild corneal abrasion 1 1 1 0
Example Case #2 F/U visit: 24 YOWM scratched R eye with branch while mowing yesterday; vision much better, no pain, little redness
F/U visit: 24 YOWM scratched R eye with branch while mowing yesterday; vision much better, no pain, little red
mild corneal abrasion 1 1 1 0
Example Case #3 67 YOBF c/o blurred VA OU, worse in pm when driving, gradual onset; glare & sun a problem.
67 YOBF c/o blurred VA OU, worse in pm when driving, gradual onset; glare & sun a problem.