EM Auditing

If not documented, it’s not done

EM coding is more complex, as may factors need to be analysed. Medical Decision Making is the difficult part. Accurate coding of MDM level needs experience and expertise. It’s very difficult to get the experience EM coders.

Medesun provides EM coding services, helps you to code appropriately and avoid the potential audits due to up coding.

Medesun team works on outpatient and inpatient visits, audit every record as per EM coding guidelines and educate the physician for the potential documentation errors.

Medesun team of certified coders will code your charts with 24-48 hours

Payments for Evaluation and Management Services – Update from Office of Inspector General – Fiscal Year 2011 Work Plan Medicare Part A and Part B – Page 1 -14

Payments for Evaluation and Management Services – Update from Office of Inspector General – Fiscal Year 2011 Work Plan Medicare Part A and Part B – Page 1 -14

We will review the extent of potentially inappropriate payments for E&M services and the consistency of E&M medical review determinations. CMS’s Medicare Claims Processing Manual, Pub. No. 100§04, ch. 12, § 30.6.1 instructs providers to “select the code for the service based upon the content of the service” and says that “documentation should support the level of service reported.” Medicare contractors have noted an increased frequency of medical records with identical documentation across services. We will also review multiple E&M services for the same providers and beneficiaries to identify electronic health records (EHR) documentation practices associated with potentially improper payments.

Evaluation and Management Curriculum is a comprehensive training program designed to prepare users to accurately assign procedure codes for evaluation and management (E/M) services.

Fundamental concepts of coding and documentation for E/M services, including procedures for

assigning the E/M level based on physician documentation.
Physician Office Services,
Physician Hospital Services,
Preventive Services, and
Critical Care and Emergency Services.

• Code accurately and ethically, according to the latest HCFA and CCI guidelines
• Correctly document each level of E&M service, according to HCFA guidelines
• Properly use E&M modifiers
• Accurately select new, established, consultation, and hospital visit codes
• Use coding tools and resources to improve coding accuracy

Case Study Review – Peripheral Interventions with/without Cardiac Catheterization What you will learn

Module 1 : Evaluation and Management Overview

The Evaluation and Management Overview course is the first course in the Evaluation and Management (E/M) Curriculum. This course will introduce the user to the concept of evaluation and management services and will provide an orientation to the Coding Metrix E/M Curriculum.

Module 2 Evaluation and Management Principles

This Course teaches participants the basic principles of evaluation and management coding, including key concepts, definitions, and fundamentals of medical documentation.

This course is designed to familiarize users with the fundamental principles of evaluation and management (E/M) documentation and coding. Participants will learn the definitions of the key and contributory components of the E/M service as well as other important concepts such as encounter time and new versus established patient.

AMA’s Documentation Guidelines for Evaluation and Management Services. You will learn how to identify key medical record documentation that supports the E/M level of service.

You will also learn the differences between the 1995 and the 1997 versions of the Documentation Guidelines and the implications of these differences for E/M code assignment.

The mechanics of E/M code selection will be reviewed in detail, and users will gain confidence in code assignment through completion of multiple choice exercises and actual case studies (physician reports).

At the end of the Course, the user will complete a scored assessment that tests the key learning points and confirms comprehension.

Upon successful completion of this Course, You will be ready to begin a more in-depth study of the various E/M service categories, including physician office and hospital services, critical care, etc. These areas are covered in the other Courses of the Evaluation and Management Curriculum.

Module 3 Physician Office Services

The Evaluation and Management Physician Office Services Course is part of the Coding Metrix, Inc. Evaluation and Management Curriculum. This course is designed to prepare users to assign evaluation and management (E/M) codes for services provided in the physician office, including new patient visits, established patient visits, and office consultations.

You will learn key concepts associated with office E/M services, including new patient versus established patient, encounter time, counseling, etc. You will also learn to identify key medical record documentation that is required to support the various categories and levels of office E/M services. Criteria for distinguishing between consultations and office visits will be discussed in detail.

The mechanics of E/M coding for office services will be reviewed in depth, and users will gain confidence in code assignment through completion of multiple choice exercises and actual case studies (physician reports).

At the completion of the Course, You will complete a scored assessment that tests the key learning points and confirms comprehension.

Module 4 Physician Hospital Services

This course prepares You to accurately assign evaluation and management codes for physician services provided in the hospital setting.The Evaluation and Management Physician Hospital Services Course is part of the Coding Metrix, Inc. Evaluation and Management Curriculum.

This course is designed to prepare users to assign evaluation and management (E/M) codes for services provided in the hospital setting, including initial hospital care, subsequent hospital care, observation care, and hospital discharge day management.

You will learn key concepts associated with hospital E/M services, including the distinction between inpatient and observation care, the definition of an interval history, and the guidelines for patients admitted and discharged on the same date. They will also learn to identify key medical record documentation that is required to support the various categories and levels of hospital E/M services.

The mechanics of E/M coding for hospital services will be reviewed in depth, and users will gain confidence in code assignment through completion of multiple choice exercises and actual case studies (physician reports).

Module 5 Critical Care and Emergency Services

This Course prepares You to accurately assign evaluation and management codes for services performed in the critical care, emergency department and neonatal intensive care arenas.

The Evaluation and Management Critical Care and Emergency Services Course is part of the Coding Metrix, Inc. Evaluation and Management Curriculum.

This course is designed to prepare You to assign evaluation and management (E/M) codes for services provided in the critical care, emergency department, and neonatal intensive care settings, including emergency department visits, adult critical care, neonatal critical care, and pediatric critical care.

You will learn key concepts associated with these services, including the definition of critical illness or injury, age categories for critical care, and services that are included in critical care. They will learn the unique rules for assigning the E/M level in the emergency department, including the definition of a complete past/family/social history for an emergency department service, and the special instructions for a Level 5 emergency department service.

The mechanics of E/M coding for critical care and emergency department services will be reviewed in depth, and users will gain confidence in code assignment through completion of multiple choice exercises and actual case studies (physician reports).

At the completion of the Course, You will complete a scored assessment that tests the key learning points and confirms comprehension.

Module 6 Preventative Medicine Services

This Course prepares You to accurately assign evaluation and management codes for preventive medicine services.

The Evaluation and Management Preventive Services Course is part of the Coding Metrix, Inc. Evaluation and Management Curriculum. This course is designed to prepare You to assign evaluation and management (E/M) codes for preventive services such as well child visits and well adult visits.

You will learn key concepts associated with preventive services, including patient age categories and initial versus periodic preventive services. They will also learn to identify key medical record documentation that is required to support the various categories and levels of preventive services. Criteria for distinguishing between a “sick” visit and a preventive visit will also be discussed.

The mechanics of preventive service E/M coding will be reviewed in detail, and users will gain confidence in code assignment through completion of multiple choice exercises and actual case studies (physician reports).

At the completion of the Course, You will complete a scored assessment that tests the key learning points and confirms comprehension.