Updating medical assistants cert
Family Practice, Internal Practice, Ophthalmology, General Surgery, Cardiology, Nephrology, Podiatry, Orthopedic Surgery, Psychiatry etc…67 CPT CODE 99213 • 99.3% of the claim errors related to 99213 included * Insufficient documentation • Other E/M codes typically had a 2:1 ratio of errors between insufficient documentation and coding.The split/shared E/M visit applies only to select E/M visits and settings (i.e., hospital inpatient, hospital outpatient, hospital observation, emergency department, hospital discharge, office, non-facility clinic visits and prolonged visits associated with these E/M visit codes).The split/shared E/M policy does not apply to critical care services or procedures. • Insufficient documentation • No response to documentation request • Illegible • Documentation for wrong patient or date of service submitted • Documentation does not support level of E/M billed • Documentation does not adequately describe the service defined by the CPT/HPCS code, or HCPCS modifier billed • Signature issues - no signature (or no legible signature) and no signature log or attestation submitted • Does not meet key elements - medical decision making, history or physical exam for billed E/M service level Reimbursement Guidelines CPT guidance instructs that E/M (CPT codes 99201-99499) should only be reported by Physicians or specific non-physician practitioners (NPP).In accordance with CMS guidelines, CMS will only pay for E/M services for nurse practitioners (NP), clinical nurse specialists (CNS), certified nurse midwives (CNM) provided they are allowed to bill for those services.Physician assistants (PA) are also allowed to provide the service as along asthe physician collaboration and general supervision rules are applied.
Examples of settings include: • Office or other outpatient setting • Hospital inpatient • Emergency department (ED) • Nursing facility (NF) 65 E/M CLAIM PROJECTED ERROR RATE 66 E/M SERVICE ERRORS • E/M remains the number one Part B CERT error • E/M services are the top 7 out of 10 services with CERT errors • The provider types performing E/M services vary greatly – i.e.The service should be documented during, or as soon as practicable after it is provided in order to maintain an accurate medical record. Selection of Level Of Evaluation and Management Service Instruct physicians to select the code for the service based upon the content of the service.The duration of the visit is an ancillary factor and does not control the level of the service to be billed unless more than 50 percent of the face-to-face time (for non-inpatient services) or more than 50 percent of the floor time (for inpatient services) is spent providing counseling or coordination of care as described in subsection C.Note: This interactive worksheet was created as a tool to assist providers and is not intended as a replacement for the 19 E/M documentation guidelines published by the Centers for Medicare & Medicaid Services (CMS).https://com/EM/165590Billing Guide CPT code 99499 Reporting CPT code 99499 (Unlisted evaluation and management service) should be limited to cases where there is no other specific E/M code payable by Medicare that describes that service.