Evaluation & Management Essentials

Minimize your risk of E&M claim denials, payment downgrades and takebacks

In facilities across the country, reviews of evaluation and management claims have resulted in widespread denials, payment downgrades and even Medicare takebacks. Among the primary culprits: incomplete or incorrect documentation to support E&M code assignments. This indispensable handbook delivers comprehensive guidance with fully and correctly documenting E&M services in compliance with CMS and AMA guidelines. It also educates coders about what documentation they need to support their E&M code assignments. Coders, audit and compliance staff, physicians, clinic staff and others will find this to be an ideal how-to resource.

Features and Benefits:

• Step-by-step documentation guidelines — detailed information covering E&M services in all settings and situations, including emergency departments, observation care, inpatient and outpatient consultations, nursing facilities and care plan services
• At-a-glance resources to help streamline coding and documentation
• Thorough explanations of E&M components, including history, examination, medical decision-making and medical necessity
• Official documentation guidelines, plus discussion of how to interpret and apply the guidelines; includes a detailed comparison of 1995 and 1997 guidelines
• Modifier discussion — how to appropriately append modifiers to services, with specific examples of the proper and improper use of modifier 25
• Tips for staying compliant and avoiding payment penalties and/or claim reviews
• Case studies to reinforce best practices for supporting E&M code assignments
• Correct documentation examples covering a variety of scenarios; includes customizable sample forms
• Tables breaking down all categories of E&M services and the requirements for each