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.
1
May 20, 2013
? 2013 Copyright, CGS Administrators, LLC.
Basics of
Evaluation and
Management (E/M)
Services
Webinar | Kendra Pickle, RN | May 21, 2013
Disclaimer
3
?
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.
May 20, 2013
? 2013 Copyright, CGS Administrators, LLC.
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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May 20, 2013
? 2013 Copyright, CGS Administrators, LLC.
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:
?
5
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)
May 20, 2013
? 2013 Copyright, CGS Administrators, LLC.
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