The 99000 E&M Codes

1. The 99000 E&M Codes • Using Dr. Quack’s Score Sheet to understand the Evaluation & Management Codes • The updated score sheet can be found on pages 11 and 12 of http://nebraska.aoa.org/documents/ne/2010-05-3RD-PARTY-NEWLSETTER.pdf

2. The 99000 E&M Codes • The Quack score sheet we are using today can be found on pages 11 and 12 of http://nebraska.aoa.org/documents/ne/2010-05-3RD-PARTY-NEWLSETTER.pdf • The score sheet has been updated from the hard copy mailed in early May…there was an omission in the history section (We can work around it today, however).

3. The 99000 E&M Codes • E&M coding is based on 3 key components: • History (There are 4 levels of complexity) • Examination (4 levels) • Decision Making (4 levels) • First, the level of complexity of each of these components is determined. • Then the final level of service is determined, based on those levels of complexity.

4. The 99000 E&M Codes • Levels of service are scored differently for New vs. Established patients. For New Patients, the complexity of the • History, • Exam, and • Decision making …must all three be considered.

5. The 99000 E&M Codes • For Established patients, only two of the three key components must be considered. • However, it is best to ALWAYS consider Decision Making. • THE RESULTING CODE MUST BE REASONABLE AND NECESSARY. The Decision Making Score helps assure that is the case.

6. Key Component #1: History • Made up of • Chief Complaint • History of Present Illness (HPI) • Review of Systems (ROS) • Past, Family, & Social History (PFSH)

7. http://nebraska.aoa.org/documents/ne/2010-05-3RD-PARTY-NEWLSETTER.pdfhttp://nebraska.aoa.org/documents/ne/2010-05-3RD-PARTY-NEWLSETTER.pdf Link on slides 1 & 4

10. History of Present Illness • Made up of • Location[example: “od”, “os”, “ou”, “upper”…] • Quality [“sharp”, “dull”, “stabbing”...] • Severity[“mild”, “severe”….] • Duration[“short”, “constant”, “hour or so”…] • Timing[“morning”, “nighttime”...] • Context[“driving”, “reading”…] • ModifyingFactors[“bright light”, “when tired”…] • AssociatedSigns & Symptoms[“headache”…] •  OR ThreeChronic or inactive conditions • 1.____________[AMD…] • 2.____________[Cataract…] • 3.____________ [EBMD…]

12. Review of Systems • Made up of • Constitutional (weight loss, etc.) • Eyes • Ears, Nose, Mouth, Throat • Cardiovascular • Gastrointestinal • Genitourinary • Integumentary (skin, breast) • Musculo-skeletal • Neurological • Hematologic Lymphatic • Respiratory • Endocrine • Allergic Immunologic • Psychiatric • All others negative (= 9)

16. Past, Family, Social History

18. http://nebraska.aoa.org/documents/ne/2010-05-3RD-PARTY-NEWLSETTER.pdfhttp://nebraska.aoa.org/documents/ne/2010-05-3RD-PARTY-NEWLSETTER.pdf

21. Key Component #2: Examination • Made up of • Acuity • Adnexae, lids, lacrimal sys, pre-auriclar nodes • Cornea • IOT • Confrontation Fields • Conjunctiva, bulbar & palpebral • A/C • Retina, vessels, exudates, hemorrhages (dilated) • Ocular Motility • Pupil/Iris, APD • Lens • Disc, Cup, NFL (dilated) • Systemic elements that briefly assess mental status or general constitution • Oriented to time/location & mood • General Constitution

26. Key Component #3:Decision Making • Made up of • Diagnosis and Management Options • Data Complexity • Risk • Very Important: Can be used to determine whether the ultimate level of service is truly “REASONABLE AND NECESSARY”

33. Am I Going to Need to Use One of These Forms For Every 99000 Exam? • Nope. Once you’ve done a number of them, you’ll know intuitively what to bill on almost all of the more common diagnoses. • Keep the forms available for the unusual situations, however. • Now, for some examples………….

34. Example Case #1 24 YOWM scratched R eye with branch while mowing this morning; blurred vision, mild, scratchy red eye..

35. 24 yowm scratched R eye with branch while mowing this morning; blurred vision, mild, scratchy red eye..

39. mild corneal abrasion 1 1 1 0

41. Example Case #2 F/U visit: 24 YOWM scratched R eye with branch while mowing yesterday; vision much better, no pain, little redness

42. F/U visit: 24 YOWM scratched R eye with branch while mowing yesterday; vision much better, no pain, little red

46. mild corneal abrasion 1 1 1 0

48. Example Case #3 67 YOBF c/o blurred VA OU, worse in pm when driving, gradual onset; glare & sun a problem.

49. 67 YOBF c/o blurred VA OU, worse in pm when driving, gradual onset; glare & sun a problem.