Coding and Documentation

The AMA’s CPT Editorial Panel approved sweeping changes to documentation and code selection guidelines for evaluation and management codes. If finalized, the changes will shift the way practices select codes for both office and facility visits as soon as January 2021.

Q: We recently had a consultant recommend that we create evaluation and management (E/M) levels for our labor and delivery observation cases, similar to our emergency room levels. Does anyone do this? If so, would you be willing to share your criteria and logic used?

On January 29, NAHRI presented its first members-only quarterly call of the year, where members heard from revenue integrity experts on engaging clinical staff, chargemaster updates, and addressing denials at their root cause.

A Comprehensive Error Rate Testing (CERT) study showed that insufficient documentation causes most improper payments for observation and inpatient care services, according to the January 2019 Medicare Quarterly Compliance Newsletter.

Overcome E/M obstacles with a collaborative internal audit process.

CMS released additional instructions to the Medicare Claims Processing Manual for the accurate interpretation of claim edits and assignment of modifiers -59 and -91 on Medicare Part B claims.

Put these practices into place to overcome clinical validation denials for these services.

Check your processes to implement E/M documentation changes, code updates, and expanded laboratory reporting requirements.

Understand how payment policy changes, C-APC changes, and more will impact your organization.

CMS recently released the 2019 NCCI Policy Manual for Medicare Services, which includes updates to payment policies and coding methodologies effective January 1.