This course will explain the criteria for coding evaluation and management (E/M ) services in the emergency department (ED) and in outpatient clinics. The lesson will cover facility E/M coding, describe Type A and Type B emergency departments, and identify situations where services may be separately billable. This lesson may feature information on the use of medical and procedural codes, including CPT codes as they relate to the subject matter presented.
“This program has been approved for 0.5000 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.”
This activity is approved for 0.5000 contact hours.
Outline:
Section 1: Introduction
About This Course
Learning Objectives
Background
Section 2: Guidelines
Internal Guidelines
Distribution of Visits
Review
Basics of Facility E/M Coding Guidelines
Additional Guidelines
Methodology
Review
Section 3: Types of Services
Coding by Site and Type of Service
Critical Care
Review
Section 4: Separate Services
Modifiers
Separately Billable Procedures
Example of Reporting Separately Identifiable Services
Telehealth Services
Review
Section 5: Conclusion
Course Summary
Course Contributors
References
Subject Matter Expert: Veronica Ziac, MBAJean Russell has over thirty years of healthcare and information system experience. Her areas of expertise include the Medicare outpatient prospective payment systems (APCs, and APGs), as well as ICD-10-CM/PCS training, Charge Description Master (CDM), admission status reviews, and outpatient coding and compliance. She is a frequent speaker at the national, state and local levels for HFMA and AHIMA professional groups. Jean has her Masters from the University of Houston in Biomedical Engineering; her Bachelors from Colgate University in Biology; and her RHIT from the independent study program through the American Health Information Management Association.
Disclosure: Jean C. Russell, MS, RHIT has no Relevant Financial or Non-Financial Relationship with ineligible companies to disclose.
Veronica Ziac, MBA has over twenty years of healthcare administration experience. Her areas of expertise include revenue cycle, information systems, population health and physician practice management. Most recently, she was the Director of Revenue Cycle Integrity at Cobleskill Regional Hospital. Prior to that, Veronica was the Chief Operating Officer for a large multispecialty hospital-based physician practice based in New York. Veronica has an MBA in Healthcare Administration from Union College and a bachelor’s degree from the University at Albany. She is a member of HFMA and MGMA and has been Certified in Healthcare Compliance (CHC) by the Healthcare Compliance Association.
Disclosure: Veronica Ziac, MBA has no Relevant Financial or Non-Financial Relationship with ineligible companies to disclose.
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