Basics of Evaluation & Management (E/M) Services

Basics of Evaluation and Management (E/M) Services

? Audio is available via teleconference:

? Teleconference number: 1-800-592-2259 ? Participant code: 408029

? All lines are muted and there will be silence until the session begins.

? Questions will be addressed at the end of the session. ? A certificate of attendance and instructions for obtaining

CEU credits from the AAPC will be provided at the end of the session.

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May 20, 2013

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Basics of Evaluation and Management (E/M) Services

Webinar | Kendra Pickle, RN | May 21, 2013

Disclaimer

? This presentation was current at the time it was published or uploaded onto the CGS website. Medicare policy changes frequently so links to the source documents have been provided within the document for your reference.

? This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations. Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services.

? The Centers for Medicare & Medicaid Services (CMS) employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this guide.

? This publication is a general summary that explains certain aspects of the Medicare Program, but is not a legal document. The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings.

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Objectives

? Define medical necessity and how it relates to E/M services. ? Discuss key differences between the 1995 and 1997 E/M

guidelines. ? Identify and discuss the components of an E/M service focusing

on the three key components. ? Outline general principles of E/M documentation. ? Discuss the components of selecting the proper E/M code.

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Medical Necessity

Social Security Act 1862 (a)(1)(A): ? "No payment may be made for items or services that are not

reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member." CMS guidelines: ? Medical necessity is the overarching criterion for payment in addition to the individual requirements of a CPT code (CMS Medicare Claims Processing Manual, ch. 12, section 30.6.1)

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E/M Guidelines

There are two sets of guidelines that providers may use: ? 1995 E/M guidelines ? 1997 E/M guidelines

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Components of an E/M service

The descriptors for the levels of E/M services recognize seven components which are used in defining the levels of E/M services. These components are:

History; Examination; Medical Decision Making (MDM); Counseling; Coordination of care; Nature of presenting problem; and Time.

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Three Key Components

There are three key components when selecting the code that should be billed. These components are:

History; Examination; and Medical Decision Making.

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