Jacqueline Bauer – PESI – Evaluation & Management Coding: Maximizing Reimbursement Claims

Description

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Jacqueline Bauer – PESI – Evaluation & Management Coding: Maximizing Reimbursement Claims

Evaluation and Management (E&M) Coding is frequently one of the most challenging areas for medical coders, and at the same time are the most common codes used for services being billed. Discover how to correctly determine proper use of CPT® codes, whether to use 1995 or 1997 guidelines, and what to look for in the notes to ensure reimbursement.

Explore advantages and disadvantages of allowing the EHR to choose codes for you. Identify correct definitions of CPT® terms used and review all parts of the E&M section of the CPT® book (be sure to have your own CPT® book!). Walk away with the confidence to correctly utilize E&M codes the first time to maximize reimbursement.

Speaker
Jacqueline Bauer CPC, CPC-I, CPMA, PMCC-I, CRC, CSS, has over 25 years of coding experience and 15 years of experience as an instructor. She is a CPC credentialed instructor with the American Academy of Professional Coders, an ICD-10 instructor and examination administrator, and a Certified Professional Medical Auditor. Ms. Bauer has prepared countless individuals for the CPC credential exam and transition to ICD-10, in addition to being a Medical Coding Instructor at Rowan College.

Speaker Disclosures:

Financial: Jacqueline Bauer is an instructor at Rowan College. She receives a speaking honorarium from PESI, Inc.

Non-financial: Jacqueline Bauer has no relevant non-financial relationship to disclose.

Objectives

1. Identify the difference between consultations and transfer of care
2. Determine proper service level based on key components
3. Apply critical care codes correctly
4. Develop strong documentation that will back your billing
5. Reduce your risk of up coding/fraud/abuse
6. Distinguish when to use 1995 vs 1997 guidelines

Outline

• Terminology
  New patient
  Established patient
  On call for another physician
  Consultation
  Transfer of care
  Oversight services
  Additional important terms
• Services
  Location
  – Outpatient
  – Office
  – Hospital observation
  – Hospital inpatient
  Type
  – New vs. established patients
  Level
  – Key components to select service level
  — History
  — Examination
  — Medical decision making
  Modifiers
• Critical Care
  10 commandments of critical care
• Documentation

Target Audience

• Coding and Billing Staff
• Physicians
• Nurse Practitioners
• Physician Assistants
• Medical Records Personnel
• Office Managers
• Medical Assistants
• Revenue Cycle Staff
• Reimbursement Staff 

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