This webinar will discuss the 2021 CPT Evaluation and Management Guidelines for time-based coding as well as the 19995 & 1997 Guidelines for code selection based on what is now being called Medical Decision Making.
We will learn about documentation deficiencies and discuss ways to create best practices that will allow your provider to give you that documentation you need to code for ALL of the services they are providing. We will look at what is probably the most important question when it comes to determining how to choose and Evaluation & Management Code… “When should I use MDM versus Time?” Do I use time in every case or only when it results in a higher code for my provider?
One vital definition of how we look at which method to use is the definition of time. This has been redefined by the American Medical Association as “total time spent on the day of an encounter” This no longer means total face-to-face time with the patient. This will make it pretty easy to get to that higher code level, right? Maybe, but what about medical necessity? Does that support the higher code? Because, we all know, the payer will down code that for you if they do not agree.
The content of this webinar will go into detail about what defines time. What SPECIFIC activities fall into the category of time and how to track who is doing what and when.
When it comes to Medical Decision Making, should providers using time-based billing just skip the HPI and physical exam because they no longer count anyway? NO, NO, NO! Remember the importance of History and exams that are necessary to support Medical Decision Making and how all of these components still work together.
The Table of Risk is the third area we will learn about in this session. What is the level of risk for each encounter, how do you identify the presenting problems for each encounter, what diagnostic procedures were ordered or performed, and finally, what are the Management Options for the conditions identified in the assessment and plan?
Always on the top of our minds are the number and complexity of problems addressed. Let’s dive into how we identify these components and what we give credit for. Are we looking at a self-limited or minor problem or is the provider diagnosing an untreated new problem that will require additional workup? How do comorbidities factor into this determination?
At the conclusion of the lecture portion of this session, I will present multiple case samples that we will be able to review and work through together to gain a better understanding of the time-based coding guidelines. And, also remember that all CPT Evaluation and Management Codes that are outside of the new and established Office or other Outpatient visits codes are still applying the 1995 and 1997 Coding Guidelines, so we will provide a refresher on using those as well as a review of the Audit worksheets provided by AAPC for both sets of guidelines to audit codes.
- Understand the 2021 E/M Guidelines for 99202 – 99215 New & Established Office Visits
- Understand the differences between time-based coding and those codes that still use MDM
- Communication methods for teaching providers how to document services and ways to increase documentation accuracy and proficiency
- It all goes back to Medical Necessity – we will go over different definitions for a better understanding of it.
- 1995 & 1997 Evaluation & Management Coding Guidelines
Areas Covered in the Session:
- CPT Coding
- HCPCS Coding
- ICD-10-CM Coding
- Medical Necessity
- Time-based Coding
- Hierarchal Condition Coding
- Upcoming Changes
- 2022 Readiness
- 1995 & 1997 Guidelines still apply
- HPI/Physical Exam/ MDM
- Coders – of all levels
- Billers – of all levels
- Coding and Billing Managers
- Operations or Practice Managers
- Nurse Practitioners, APRNs, etc.
About the Presenter:
Tricia has more than two decades of experience in medical billing, coding, auditing, consulting, teaching, and mentoring. She started her career in the field of workers’ compensation as an adjuster and transitioned to coding after almost ten years in that role. Tricia is a Coder and Auditor for a large multi-state Healthcare System and is also a billing instructor teaching our future generations of billers and coders.
Tricia is the owner of a Consultancy Firm teaching, mentoring, training, and coaching aspiring coders. She lives and works in the beautiful State of Alaska and is presently serving on the AAPC Chapter Association Board of Directors in addition to being the President of the Anchorage, Alaska AAPC Local Chapter. She provides virtual and in-person presentations on a multitude of topics and concepts as well as virtual and in-person training and study courses (PMCC), she is also available to provide exam review sessions, both in-person and virtually. You can also find some of her work in the AAPC Healthcare Business Monthly Magazine as she is a published author and contributor on a regular basis, sharing her knowledge and expertise in the field.
Operating System: Windows any version preferably above Windows Vista & Mac any version above OS X 10.6
Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to talk and hear clearly
For more information you can reach out to the below contact:
Toll-Free No: 1-302-444-0162