Session # 1 - When Minutes Matter – How Carriers Define E&M Code Minutes Differently
Live Date - April 17, 2025
Time - 1 PM ET
Duration - 60 minutes
There are many codes in the Evaluation and Management section of the CPT book that have an amount of time assigned to them. Sometimes, the code is entirely defined by the minutes spent. Other times, the codes can be determined by the time spend as a secondary method of level selection.
To understand the concepts of coding based on time, we need to take a step back and remember what our HIPPA defined rules say. These rules defined that the HCPCS code system, of which CPT is a part, is THE coding system to be utilized for procedures and services. But HIPPA did NOT indicate that the guidelines of CPT are the guidelines that must be followed. So, for a particular code, CPT may indicate one way a code should be utilized while another insurance may have their own way. Just as CPT guidelines may say that you only need to get past the halfway point of the time listed for a particular service, but CMS/Medicare guidelines state you must get all the way to the end of that time period.
Currently, there are Evaluation and Management time-based codes that are billed incorrectly to insurances, because of differing guidelines. Your practice’s revenue could take a severe hit if incorrect coding is identified by payers. The problem isn’t necessarily the difference between two levels of a particular service, but rather in the penalties for the error.
Understanding the differing guidelines of codes is the goal of this webinar. Tips on how to properly assign codes in working with physicians is an added benefit of it.
Webinar Objectives
- Time based codes – understanding which E&M codes have time requirements or options for billing
- How much time is required to meet guidelines for use of a particular code
- Differing guidelines – which codes do differing guidelines most severely affect chances of fraudulent billing
Webinar Agenda
- Overview of Evaluation and Management Codes
- Identifying codes that have time requirements
- Discussion regarding minimum time requirements for code selection
- Documentation of time for codes
Webinar Highlights
- Evaluation and Management codes – codes with time requirements
- Evaluation and Management codes – codes that have time as an option for level of service differentiation
- Documentation of time
- Differing guidelines from insurance carriers that cause billing headaches and concerns of billing fraud
- Tips on communicating with your providers to glean information needed to properly bill for services
Session # 2 - Auditing E/M Visits in 2025
Pre-recorded Webinar (get instantly)
Duration - 60 minutes
When Office and Other Outpatient Services saw their major change in documentation rules in 2021, there were many new guidelines and rules to try to understand and adjust to. When the changes to other Evaluation & Management codes occurred, following suit, in 2023, we still did not understand well all the changes that had been made. Now adding on to the initial set of changes were a few additional ones. Finally, as we had waited patiently, carriers, through releases on FAQ, articles and audits, gave us little titbits of information to help clarify what was acceptable to them for documentation in these new rules for E&M services.
As we are now in the fourth year since the initial changes were made to E&M documentation guidelines, we are gaining valuable information for what phrases like “problem addresses”, independent report” and “prescription drug management” mean for provider’s documentation.
Providers seem to be having difficulty stopping old habits of documenting complete history and physical exam elements even though that requirement has changed. Understanding the changes that were made that can save the providers significant time in their documentation and make auditing of those records significantly easier with reasonable changes in documentation. One of the major issues is provider’s seeming reliance on drop down documentation and pre-populated templates instead of, often times, quicker narrative documentation.
Webinar Objectives
The session will walk through the Elements of Decision-Making table. Requirements of the differing levels of service (i.e. low and moderate) will be reviewed. Discussions of frequently seen incorrect documentation will occur along with offering documentation tips to be utilized in educating providers.
Webinar Agenda
Beginning with problems addressed from the first column of the Elements of Medical Decision Making, documentation rules and policies will be discussed. Then, a discussion of what the complicated items are in the middle column or amount and/or complexity of data to be reviewed will occur. Explaining what the nuances are for historian and personal interpretation are in documentation will occur next. Finally, the risk column will be discussed. First explaining that this is the risk of the treatment to the patient and showing the difference it is from the risk from the illness will occur. Then other elements such as prescription drug management, social determinants of health will be discussed along with others.
Webinar Highlights
- Table of the Elements of Medical Decision Making
- Description of each of the three columns
- Documentation requirements of each
- Time based code selection and its documentation requirements
- Pitfalls in documentation, what simple notations can tank a note and cause it to fail audit
Who Should Attend
Coders, Billers, Auditors, Compliance, Office Manager, Office Administrator
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