Online continuing education units (CEUs) have revolutionized the way chiropractors stay updated with the latest industry practices. One area that often confuses both seasoned practitioners and newcomers alike is the complex world of coding, specifically Evaluation and Management (E/M) coding. Mastering E/M coding, especially in the context of time, can optimize billing and enhance the quality of patient care. Let's delve into it.
The American Medical Association (they own the CPT code set) updated the criteria for E/M coding in January 2021. The changes allow practitioners to establish the correct E/M code level based on either medical decision-making or time. However, it's essential to remember that while the E/M codes no longer use histories and physical exams for determining the level, a medically appropriate history and physical examination are still part of standard care.
Three critical elements must be considered when using MDM for E/M coding:
Understanding these elements requires a detailed comprehension of each criterion and how they interplay with documentation.
In contrast, when you code E/M services based on time, the procedure becomes more straightforward. The catch is understanding the rules of coding with time, which can be broken down into four significant rules:
Time spent by the physician in face-to-face interaction with the patient or caregiver and non-face-to-face time spent by the physician on the day of the encounter count for coding purposes. Support staff time does not count.
All time spent on the date of the encounter, both morning and afternoon, can be added. However, any time from another date won't count.
Activities like preparing for the patient, counseling, ordering tests, and documentation, among others, must be carried out by the physician to count towards the total time.
The codes are divided based on new or established patients and are allocated depending on the time spent.
Your billing patterns should be consistent with the patient’s condition and complexity. Using a balanced approach to coding can help you remain in compliance and reduce the risk of being flagged by third-party payers.
Learning to navigate the intricacies of E/M coding is critical for every practicing chiropractor. CCEDseminars offers online courses tailored to your needs. From basic to advanced coding practices, count on us to help you stay updated and compliant. Click HERE for awesome clinical pearls!
Mastering the rules of coding with time for E/M services is an invaluable skill for chiropractors. Not only does it help in offering better patient care, but it also ensures optimal billing practices. In the fast-paced world of healthcare, staying updated through chiropractic CEU online is not just a requirement but a necessity for thriving practice.
For more valuable insights, don't hesitate to check out our range of courses at CCEDseminars. Stay informed, stay compliant. Click HERE!
References
https://ama-assn.org/practice-management/cpt
https://ama-assn.org/practice-management/digital/ama-telehealth-policy-coding-payment