Learn more about selecting Category of Code in Everyday Coding, updated annually. This article provides definitions and tips for determining whether an office encounter involves a new patient, an established patient, or a consult, and the guidelines for reporting inpatient, observation, and emergency services. The quick reference chart and key points will help you to quickly […]
E/M Services
For many practices, E/M services are what you do the most. Knowing what type of service to bill, what level of service and the rules related to the visit will decrease denials and payment delays. Here you'll find an overview, MDM and rule changes, resources organized just like your CPT book, and a bonus section with E/M frequency data.
2023 E/M Guidelines for Hospital, Nursing Facility, Home and Residence Services | Webinar
Recorded September 22, 2022
As expected, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. They extended the documentation framework in place for office visits to these codes. They also deleted twenty-five codes. Coding for prolonged care services gets…
Coding Guide – E/M Services
This coding guide describes the guidelines for evaluation and management (E/M) services reported in the office or outpatient department, consultations, ED visits, inpatient and observation hospital visits, nursing facility and home services. There are specific changes related to these categories of codes described here. The guide will also discuss how to select the level of service based on either time or medical decision-making.
E/M Services – History and Exam
History and exam for E/M services “E/M Codes that have levels of services include a medically appropriate history and/or physical examination when performed. The nature and extent of the history and/or physical examination is determined by the treating physician or other qualified healthcare professional reporting the service. The care team may collect information and the […]
New Versus Established Patient Visits
There are other articles on CodingIntel about the difference between new and established patients, and the rules haven’t changed, but that doesn’t mean it is always clear. This article is here to try and clarify any remaining questions you have about the differences. Medicare definition “Interpret the phrase “new patient” to mean a patient who […]
Emergency Department Visits
Definition Emergency department (ED) services are E/M services provided to patients in the Emergency Department. Explanation These services may be billed by any specialty physician, not just Emergency Department physicians. The physician does not need to be assigned to the ED. However, these codes may only be used in a hospital-based facility that is available […]
CPT® and CMS Rules for Critical Care | What’s the Difference?
CMS and CPT count critical care time differently. For Medicare patients, the full 30 minutes of 99292 must be met in order to use the code, not the midpoint (15 minutes) of the code. For Medicare patients: Use 99291 from 30 minutes until 103 minutes. Add on code 99292 only if the time meets 104 […]
Non-Face-to-Face Prolonged Service – 99358
This article covers: CPT® Rules for Prolonged Care Non-Face-to-Face Using 99358 for Phone Calls There are two time-based CPT® codes for non-face-to-face prolonged care services. These codes may not be used on the day of an Evaluation and Management (E/M) service, such as an office visit or hospital service. Physicians and other qualified health care […]