E/M 2023 A New Era for Documentation

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This year the American Medical Association (AMA) in agreement with the Centers for Medicare and Medicaid Services (CMS) made significant changes to E/M services that will require a complete change in the way services are coded outside of the office setting. In 2021 documentation guidelines for documenting and charging for office/outpatient services were significantly changed. In 2023 all E/M services will now fall under the same guidelines introduced for office/outpatient services. Gone are the 1995 and 1997 documentation guidelines. This seminar will explore those changes, code deletions as well as many changes to specific CPT E/M categories. In addition, we will review the significant new guidelines for E/M services.

Learning Objective:

  • Know the new documentation guidelines and coding for E/M services outside of the office setting
  • Understand the reasoning behind deleted codes and code categories
  • Be able to apply medical decision-making criteria for choosing a level of service
  • Know when and what prolonged services codes to report depending on the payer

Areas Covered in the Session

  • AMA’s decision-making criteria
  • Time factors when using time as the defining criteria for choosing a level of service
  • Deleted E/M services or categories
  • New combined E/M categories
  • Prolonged services
  • CMS’s answer to controversial AMA guidelines and services
  • Specific criteria for Emergency Department billing
  • 2023 CPT EM Changes
  • Deleted Codes and Categories
  • Combined Categories
  • Hospital/Observation Guidelines
  • Nursing Facility Guidelines
  • Consultation Services
  • Emergency Department Changes
  • Challenge – HPI & Exam
  • Decision Making
  • Number and Complexity of Problems
  • Morbidity
  • Complexity of Problems Definitions
  • AMA Complexity of Problems Errata
  • Complexity of Problems AMA Errata
  • Amount/Complexity of Data Reviewed and Analyzed Clarifications
  • Data Errata Clarifications – Analyzed
  • Data Errata Clarifications – Unique Tests
  • Data Clarifications – Independent Interpretation
  • Data Errata Clarifications – Unique Source
  • Data Errata Clarifications – Discussion
  • AMA Data Clarifications – Independent Historian
  • Risk Patient Management
  • AMA Risk Errata Clarifications – Surgery
  • AMA Risk Errata Clarifications – Drug Therapy
  • AMA Risk Errata Clarifications – Assessment & Plan
  • Risk Patient Management Categories
  • Office Outpatient EM Time
  • Hospital/Observation EM Time
  • Hospital/Observation Admission Discharge Same Day Time
  • Office/Outpatient Consultation EM Time
  • Inpatient/Observation Consultation EM Time
  • Nursing Facility EM Time
  • Home/Residence EM Time
  • Time Issues
  • Prolonged Attendance Time
  • Prolonged Services Changes
  • 99358 & 99359 Non-F2F
  • 99415 & 99416 Staff Prolonged Time
  • CMS Prolonged Services Change
  • Preventive/Problem Oriented Service Same day
  • Conclusions

Suggested Attendees

  • Billing staff
  • Coding staff
  • Auditors
  • Clinic Managers
  • Physician and Non-physician Practitioners
  • Insurance Company Claims Reviewers
  • Providers
  • Coders
  • Office Managers
  • Denial resolution teams
  • Insurance payers
  • Payment policymakers
  • Compliance officers

About the Presenter

Jan Rasmussen, PCS, ACS-OB, ACS-GI, – As a healthcare consultant Jan has more than 35 years of experience in physician billing, reimbursement, and compliance. Jan is currently the owner of Professional Coding Solutions, a healthcare consulting firm. She has been a Certified Professional Coder (CPC) since 1992 with active membership in the American Academy of Procedural Coders (AAPC). As a member of the AAPC, Jan previously served on their Advisory Board as the liaison to the AMA, has been a speaker for the AAPC annual conference as well as contributing to the development of AAPC’s independent study and university education programs and proficiency tests. In 1994, she was honored by AAPC as Networker of the Year. Jan was also a Regional Governor for the American College of Medical Coding Specialists (ACMCS) serving as Chair of the Ethics committee and a member of the Examination committee.

In her role as a physician consultant, she has participated in physician coding and documentation reviews including OIG government PATH and Campus audits, and designed and conducted physician coding seminars nationwide. She has been a guest speaker for several conferences sponsored by United Communications, Inc//Decision Health, AAPC as well as Coding Institute Specialty Conferences.

In previous consulting positions she was responsible for developing and conducting seminars for basic, intermediate, and advanced ICD-9-CM and CPT, teaching physician guidelines as well as special seminars for OB/Gyn, Orthopedics, Urology, Gastroenterology, General Surgery, ENT, Cardiology, Emergency Medicine and Evaluation and Management. In her role as an educator, she has been teaching E/M documentation and auditing to both physician and coding audiences since 1992 when RBRVS was first implemented.

Jan has also worked for several major health insurance payers in Wisconsin, was a coding advisor to the WPS Medicare Carrier Advisory Committee and served as the coding and reimbursement coordinator for a 37-provider, staff model HMO clinic. As the coding and reimbursement coordinator, Jan was responsible for physician office, hospital, surgical, and nursing facility coding charge ticket development, fee development, reimbursement analysis, claims analysis, and physician education.

Course Content

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