The American Medical Association (AMA) has created new guidelines for Evaluation and Management codes for the new and established patient office visits 99202-99215 only. Later the guidelines were extended to outpatient consultations and certain inpatient services that base the level of service on medical decision making. Practitioners may choose the level of service using medical decision making or total time for these services. The AMA provided a coding tool to assist when choosing the level of service on medical decision making. The coding tool consists of the three elements of medical decision making. We will take a close look at the elements and learn how to use this tool when selecting the correct office visit code based on the documentation.

For the first time, the American Medical Association provided definitions of terms used in the coding tool. We will discuss the definitions to better understand the necessary information to include in the documentation to represent your practitioner’s work and how to credit their work in the coding tool. We will also review the allowed activities to consider when code selection is based on total time and information the time statement must include.

Learning Objectives:

• When to level the visit on medical decision making vs total time
• Definitions of terms used in the AMA’s coding tool
• Become familiar with the three elements of medical decision making
• How to document to support the elements of medical decision making
• Identify missed opportunities in the documentation
• How to select the level of service based on the documentation
• When to use medical decision making vs total time for leveling the service
• How to count time and document an appropriate time statement
• Level of service 5 visits with prolonged services
• Discuss how Medicare vs other payors count time for Prolonged Services

Areas Covered in the Session:

• Current Evaluation and Management Rules and Guidelines
• Leveling based on medical decision making
• AMA E/M Coding Tool
• AMA Definitions: Terms used in the coding tool
• Necessary documentation to support the level of service
• Leveling based on total time
• What counts for total time
• Information to include in the total time statement
• Prolonged Services

Suggested Attendees:

• Physicians and Non-Physician Practitioners
• Medical Coders
• Medical Billers
• Practice Managers
• Coding Managers
• Directors of Coding
• Denial Team
• Coding Compliance Team
• Auditors
• Revenue Cycle Team
• Outpatient Hospitals
• Outpatient Hospitals Staff