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Format:	On-Demand Webinar
Presenter:	Jan Rasmussen, PCS, ACS-OB, ACS-GI
Time:	You can access the webinar anytime
Duration:	60 minutes

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 Objectives:

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.