Textbook of Urgent Care Management: Chapter 42, Evaluation and Management of Coding and Documentation

By Sybil Yeaman

The Textbook of Urgent Care Management is now offering individual chapters for sale. The full book, provides an expert business consulting guide to potential or existing urgent care clinic owners, managers & operators as well as investors. Learn how to more effectively run your immediate care or walk-in center as well as start incorporating urgent care services into your existing primary care practice. The chapters cover valuable information from industry experts on how to start, manage, and even sell your urgent care center.

Chapter 42 includes:

Medical Necessity

Evaluation and Management Code Definitions

Evaluation and Management Levels of Service
- Putting it All Together
- Sample Scenarios of E&M Coding Levels and Medical Decision Making

Medical Documentation
- Documentation Tips
- Coding Specific to Urgent Care

• Language: English
• Publisher: BookBaby
• Release date: Mar 15, 2014
• ISBN: 9781940288499

Book preview

CHAPTER 42

Evaluation and Management of Coding and Documentation

Sybil Yeaman

from

CHAPTER 42

Evaluation and Management of Coding and Documentation

Sybil Yeaman

PROFICIENCY IN SELECTING THE appropriate level of evaluation and management (E&M) codes and thorough documentation regarding medical necessity of services in patient medical records generate correct reimbursement, facilitate compliance with regulatory guidelines, and lower malpractice risks. Inappropriate coding and lack of supporting documentation in medical records put medical providers at risk for consistent underpayments or audits for recoupment of overpayments, and higher malpractice risks. Information about E&M coding and documentation is provided here only for education purposes. Readers should always refer to American Medical Association (AMA), Centers for Medicare & Medicaid Services (CMS), and health insurance plan guidelines for specific coding and documentation requirements.

E&M codes were established in 1995, yet correct coding is still a challenge because of the complexities incorporated into the coding process for purposes of determining medical necessity and level of code for services rendered.

MEDICAL NECESSITY

Prior to the late 20th century, medical providers personally determined the medical necessity of the services they provided to their patients. Reimbursement came directly from their patients in a monetary or barter remuneration system. The increasing popularity of purchased health insurance coverage in the late