Effective January 1, 2021, E/M codes for office visits changed. E/M levels are now determined by time or medical decision-making. Since these new changes have been implemented in 2021, there have been technical corrections issued by the AMA along with numerous FAQs answered by the AMA. In this webinar, Attorney and Certified Professional Coder, David Vaughn, will guide you through the nuances of selecting the level of E/M visits based on either time or medical decision making along with the appropriate use of modifier 25 which continues to be a challenging issue for most providers. Further, for the duration of the PHE, Medicare and other payers now allow telehealth services to be billed that were not previously allowed prior to the PHE. David Vaughn will cover the types of telehealth visits that can be billed to Medicare along with documentation, modifier, and place of service billing requirements.

Learning Objective

• How does the AMA define an acute vs. chronic problem?
• How is the level of data calculated based on the MDM Table?
• How is the risk level of an office visit determined?
• What activities are included when billing a visit based on time?
• What documentation is required in order to bill an E/M visit performed via telehealth?
• What place of service and modifiers should be used when billing telehealth visits?
• How is a “stable” problem defined?
• How is the ordering and interpretation of tests used in the calculation of data for MDM?
• What is the number of minutes required for each of the office visit levels?
• When is it appropriate to bill an E/M visit on the same date as a procedure using Modifier 25?
• What is the documentation difference between an audio-video visit vs a telephone-only visit?

Areas Covered in the Session:

• Acute vs. Chronic
• MDM Data Calculation
• Risk Level of an Office Visit
• E/M Visit Billing
• Modifier 25
• Telehealth E/M Visit Billing
• Documentation Required
• Place of Services and Modifiers Use for Telehealth Services

Suggested Attendees

• Medical providers, who are involved in the payment process of their practice
• C-level executives
• Office staff and Billing Managers
• Medical Billing Companies
• Hospital Revenue Cycle Staff
• Physician
• Nurses
• Physician Assistants
• Nurse Practitioners
• Medical Assistants
• Practice Manager
• Office Managers
• Billers
• Coders
• Auditors
• CDI Specialists
• Collection Staff
• Front Desk
• IT Specialists
• HIPAA Privacy and Security officers.
• Compliance Officers
• Telemedicine System Vendors
• Patient Accounts Personnel
• Medical record supervisors
• Health Information Management Administrators and Technicians
• Other Personnel Interested in Billing Privileges with the Medicare Program

About the Presenter:

David Vaughn, JD, CPC is one of the top healthcare attorneys in the United States who is the founding member of Vaughn & Associates, LLC. He graduated from Mississippi College with Special Distinction (Magna Cum Laude) in 1974, graduated from LSU Law School in 1977, and has been a certified coder since 1999. David has served on the Legal Advisory Board of the AAPC and has written several coding and compliance books and manuals. He is also a national speaker on the legal implications of billing and coding. He also has a national healthcare law practice, and has represented over 2,000 physicians in approximately 40 states in over 10 physician disciplines. His practice consists of representing providers in federal and state prosecutions, qui tam cases, and Medicare and third-party payer audits. He also conducts audits and provides education to providers.