Part 1: 2023 Evaluation and Management Series by AMCI

AMCI Medical Coding

7 Apr 2023134:20

EducationalLearning

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TLDRThe video script is an educational session on the AMCI E M series, designed to break down the e, m guidelines into manageable parts for effective learning. The session introduces the curriculum director, Mrs. J, and the team of experts who will guide the learners through the series. The focus is on understanding and applying the 2023 guidelines, with an emphasis on coding office visits and scoring medical decision making. The script outlines various scenarios to test the learners' knowledge and understanding of the e, m guidelines, highlighting the importance of accurate documentation and the use of CPT codes and tables for precise coding.

Takeaways

📚 The AMCI E/M series is designed to break down guidelines into manageable parts for effective learning experiences.
👩‍🏫 Mrs. J, the curriculum director at AMCI, introduces the team and the structure of the E/M series, which includes annotation techniques, coding, and medical decision making.
📈 The series is divided into four parts, covering different aspects of E/M guidelines, including office visits, inpatient coding, nursing facility visits, and knowledge testing.
📆 The 2023 guidelines are emphasized throughout the series, with a focus on applying them at every step.
🏥 The importance of understanding new and established patient visits, and the distinction between initial and subsequent services, is discussed.
📝 Documentation and coding for E/M visits have changed, with a focus on total time of the encounter and medical decision making, rather than history, exam, and MDM.
📊 The use of E/M tables in the CPT manual is highlighted for accurate code selection based on history/exam, location of visit, type of visit, and total time.
🛠️ The video provides practical scenarios to demonstrate how to apply the guidelines and select the appropriate E/M codes.
📝 The process of scoring medical decision making (MDM) is introduced, with a focus on the number and complexity of problems, data reviewed, and risk assessment.
🎯 The AMCI PDR chart is recommended for learning and scoring MDM, with examples provided on how to use it for code selection.
📌 The importance of understanding and applying the guidelines for selecting the level of E/M service or code based on time or MDM is emphasized.

Q & A

What is the purpose of the AMCI E M series?
-The AMCI E M series is designed to break down the E/M guidelines into manageable, digestible nuggets to ensure the best possible learning experience for participants.
Who is Mrs. J and what is her role in the AMCI E M series?
-Mrs. J is the curriculum director at AMCI, and she is thrilled to be part of the series, leading the introduction of the fantastic team and the E/M guidelines.
What are the four parts of the E M series?
-The four parts of the E M series include: Part one discussing the AMCI annotation technique called Chun, Part two focusing on inpatient coding and hospital observation, Part three covering Nursing Facility visits and prolonged services, and Part four summarizing all the information and testing knowledge.
What is the significance of the 2023 guidelines in the AMCI E M series?
-The 2023 guidelines are considered throughout the entire AMCI E M series, ensuring that the participants are updated with the latest standards and practices in E/M coding.
What is the role of the CPC and the credentials owned by AMS and AHIMA?
-CPC is a registered trademark of AAPC, and the credentials CPC, CRC, COC, CPMAC, CPM, and CPCO are owned by AMS. On the other hand, AHIMA owns the credentials CCA, CCS, CCSP, RHIA, and RHIT, which are all relevant to the field of medical coding and billing.
What is the process of determining if a patient is new or established according to the guidelines?
-A new patient is one who has not received any professional services from the physician or another qualified health care professional of the exact same specialty and sub-specialty within the past three years. An established patient has received professional services within the same time frame.
How are the E/M codes determined based on time and medical decision making (MDM)?
-Physicians can choose whether their documentation is based on total time or MDM. The guidelines provide activities that can be carried out when performing E/M services, and these activities are used to determine the level of service or code based on either the total time of the encounter or the complexity of the MDM.
What is the role of the E/M tables in selecting the correct code?
-The E/M tables are used to select the correct code based on the total time of the encounter or the level of MDM. They provide a structured way to match the service provided with the appropriate CPT code.
What is the significance of the 99202-99215 code series in E/M coding?
-The 99202-99215 code series is used for coding office visits and represents different levels of medical decision making, from low to high, and different total times spent on the encounter, from 15 to 74 minutes.
How does the deletion of the 99201 code impact E/M coding for new patients?
-The deletion of the 99201 code directs providers to report using the 99202 and below codes for new patient services. For services 75 minutes or longer, the prolonged services code 99417 should be used.
What is the importance of using the CPT manual and MCG manual in E/M coding?
-The CPT manual is essential for E/M coding as it provides the latest codes and guidelines. The MCG manual, while not required, is recommended for additional guidance and support in accurate coding.

Outlines

00:00

📚 Introduction to AMCI E M Series

The video begins with an introduction to the AMCI E M series, designed to break down E M guidelines into manageable parts for effective learning. The series encourages repeated viewings for full understanding and offers CEUs for those who need them. Mrs. J, the curriculum director at AMCI, introduces the team including Miss Tamika, Mr. Sandeep, Miss Dolly, and Miss Jazzmeet, highlighting their qualifications and roles. The series will cover the AMCI annotation technique 'Chun', coding for office visits, and medical decision making, with a focus on the 2023 guidelines.

05:01

📈 Copyright and Guidelines Overview

The paragraph discusses copyright information for CPT and other medical coding credentials, emphasizing the use of the 2023 guidelines throughout the series. It outlines the weekly plan, covering topics from 'Chun' coding and medical decision making to changes in EM coding for various medical settings. The presenter explains the importance of having the 2023 CPT manual and provides a brief overview of the goals for the presentation.

10:01

📖 Coding Office Visits and MDM

The focus shifts to coding office visits, explaining the process of 'Chun' coding for new and established patient visits. The video details the coding for different levels of medical decision making (MDM) and total encounter times. It also addresses changes in coding for new patients, the deletion of code 99201, and the use of prolonged services code 99417 for longer encounters.

15:02

🏥 In-depth Discussion on EM Visits

This section delves deeper into evaluation and management (EM) visits, including office visits, inpatient hospital visits, and other types. It emphasizes the importance of CPT manuals and EM tables in selecting correct codes. The video introduces the concept of using charts to simplify the coding process and reviews the elements required to solve EM codes, such as history/exam, visit location, visit type, total time, and MDM level.

20:05

📊 Scenario-based Learning for EM Coding

The presenter walks through a scenario-based learning approach to demonstrate how to apply the learned concepts for EM coding. It includes a total time scenario and a medical decision making scenario, illustrating how to use the EM tables and apply all guidelines to select the appropriate code. The video aims to enhance understanding and practical application of EM coding principles.

25:05

👩‍⚕️ Determining New vs. Established Patients

The video discusses the guidelines for determining whether a patient is new or established, including the three-year rule and the specifics of initial and subsequent services. It clarifies the difference between new and established patients and provides examples to aid understanding. The video also addresses the classification of encounters when physicians are covering for each other.

30:08

📝 Scoring Medical Decision Making (MDM)

The video introduces the process of scoring MDM, explaining the use of the AMCI PDR chart for evaluating documentation. It outlines the three components scored: problems, data, and risk, with each component having its level. The video provides examples and definitions from the AMA guidelines to clarify how to score MDM accurately. It emphasizes the importance of understanding these definitions for successful MDM scoring.

35:09

🧩 Solving MDM Scenarios with Definitions

The video presents a series of scenarios where coders must determine the appropriate MDM level based on the provided information. It demonstrates how to use the definitions of problems, data, and risk to score MDM and select the correct CPT code. The video reinforces the importance of accurate documentation and the application of guidelines in the coding process.

40:10

🎓 Final Scenarios and Summarizing Learning

The video concludes with final scenarios for practice, covering a range of patient visits and conditions. It tests the coders' ability to apply the learned concepts and guidelines to real-world situations. The video summarizes the key learning points, emphasizing the importance of understanding and applying the MDM scoring process accurately.

Mindmap

Keywords

💡Medical Decision Making (MDM)

Medical Decision Making (MDM) refers to the complexity of the decision-making process required for patient care. It is a critical component in determining the appropriate level of Evaluation and Management (E/M) services provided during a patient encounter. In the video, MDM is used to assess the number and complexity of problems addressed, the amount and complexity of data reviewed, and the overall risk to the patient. It is scored on a level system (1-5) and directly impacts the coding of the E/M service.

💡Evaluation and Management (E/M) Services

Evaluation and Management (E/M) Services are healthcare services provided by a physician or other qualified health care professional during an encounter with a patient. These services include the assessment, diagnosis, and treatment of patients and are critical for determining the appropriate level of care and documentation requirements. E/M codes are used to bill for these services and are based on the type of service, the setting of the encounter, and the complexity of the medical decision-making involved.

💡CPT Codes

CPT Codes, or Current Procedural Terminology codes, are standardized codes used by healthcare providers to report medical procedures and services to insurance companies and other healthcare entities. These codes are essential for billing and reimbursement purposes and provide a common language for understanding the specific services rendered during a patient encounter.

💡New Patient vs. Established Patient

In the context of healthcare coding, a new patient is one who has not received any professional services from the same physician or group practice within the past three years. An established patient, on the other hand, has received professional services within the specified time frame. This distinction is crucial for determining the appropriate E/M code, as new patient visits typically require more extensive documentation and thus have different coding implications compared to established patient visits.

💡Prolonged Services

Prolonged Services refer to the additional time spent with a patient beyond the usual time expected for a standard E/M service. When the total time of an encounter exceeds the threshold for the typical service level (e.g., more than 29 minutes for a new patient office visit), a separate Prolonged Services code can be used to bill for the additional time. This ensures that physicians are appropriately compensated for extended care.

💡Documentation

Documentation in healthcare refers to the recording of patient encounters, including the history taken, examination performed, tests ordered, diagnoses made, and treatment plans formulated. Accurate and thorough documentation is essential for appropriate coding, reimbursement, and quality of care. It serves as the basis for determining the level of service provided and the complexity of medical decision-making.

💡Coding

Coding in healthcare involves the process of converting medical diagnoses, procedures, and services into standardized codes, such as CPT codes, for the purpose of billing and insurance claims. Accurate coding is critical for reimbursement, as well as for tracking healthcare utilization and outcomes.

💡AMA Guidelines

The AMA Guidelines, or the American Medical Association's guidelines, provide standardized rules and criteria for evaluating and documenting patient care for the purpose of coding and billing. These guidelines help ensure consistency and accuracy in the reporting of medical services.

💡Sleep Study

A sleep study is a diagnostic test that monitors an individual's physiological functions during sleep to identify sleep disorders. It is a non-invasive procedure that can involve the recording of brain waves, eye movements, muscle activity, and breathing patterns. Sleep studies are often recommended for patients with symptoms such as excessive daytime sleepiness, snoring, or suspected sleep apnea.

💡Punch Biopsy

A punch biopsy is a surgical procedure used to remove a small, circular sample of skin or tissue for diagnostic purposes. The punch biopsy tool, which is a small, cylindrical instrument, is used to cut out the tissue sample. This type of biopsy is commonly performed in dermatology to diagnose skin conditions, including skin cancer and inflammatory skin disorders.

Highlights

AMCI E M series designed to break down e, m guidelines into manageable parts for effective learning.

The importance of watching playbacks multiple times to fully grasp the guidelines.

Introduction of the fantastic team including curriculum director, assistant curriculum director, lead instructor, and approved interns.

The four-part E M series covering different aspects of medical guidelines and coding.

Discussion on the 2023 guidelines and their application throughout the series.

Explanation of the AMCI annotation technique called 'Chun' for coding EM sections.

Details on how to code office visits and score medical decision making for part one of the series.

The significance of using CPT guidelines and manuals for accurate coding.

The process of determining if a patient is new or established based on the last three years of professional services.

The difference between initial and subsequent services in terms of patient visits.

The use of EM tables for selecting the correct E M code based on history, exam, and MDM.

The guidelines for selecting the level of E M service or code based on time and MDM.

The importance of highlighting key information in documentation for accurate E M coding.

The process of scoring MDM using the AMCI PDR chart for determining the level of office visit codes.

The significance of understanding the definitions of problems, data, and risk for accurate MDM scoring.

The application of unlisted services guidelines and the use of special reports for E M coding.

Transcripts

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