Last Modified: 4/30/2020
Location: FL, PR, USVI
Business: Part A, Part B
Q: Why did the E/M interactive worksheet fail to calculate a “suggested” E/M code?
A: To determine the appropriate level of service for a patient's visit, it is necessary to first determine whether the patient is new or already established as well as where the visit took place (e.g., hospital, office, nursing facility).
If you did not make a selection in the Determining Level of E/M Services
section, which indicates the category of patient visit, the E/M interactive worksheet
cannot calculate a suggested E/M code:
The Determining Level of E/M Services section defines the category of patient visit and not only determines how many of the key components must be performed and documented but also the specific requirements, as specified in both the 1995 and 1997 documentation guidelines, for the PFSH element of the History component.
In the Determining Level of E/M Services section, your selection should be based upon the following information (as indicated within the patient’s medical record):
• Place of service (e.g., office, outpatient, hospital, nursing facility, rest home, home)
• Type of patient (e.g., new, established) or nature of the visit (e.g., initial, subsequent, inpatient, observation)
• Number of key components performed and documented (e.g., History, Examination, and Medical Decision Making)
Note: Since the 1995 and 1997 E/M documentation guidelines specify different PFSH requirements based on the category of patient visit, the Determining Level of E/M Services section should be completed before making selections within the History section.
The E/M interactive worksheet bases its calculations on the requirements specified in the E/M Documentation Guidelines for Evaluation and Management Services (1995 and/or 1997) and the selections made by the user.
Sources: 1995 Documentation Guidelines for Evaluation & Management Services
1997 Documentation Guidelines for Evaluation and Management Services
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