E/M Code Changes 2024
TLDRTerry Troen, an experienced healthcare professional and coding expert, discusses the updated guidelines and codes for Evaluation and Management (E/M) services effective from January 2024. The talk covers changes in E/M coding related to time, telemedicine services, multiple visits, and hospital observation care. It also highlights the introduction of a new add-on code, 99459, for pelvic exams in addition to the primary procedure code. The emphasis is on ensuring that telemedicine services are equivalent to face-to-face care and that the new guidelines are clear and specific to maintain accurate coding practices.
Takeaways
- 📚 Terry Troen is a certified RHIA and CCSP with a master's in healthcare administration informatics and over 20 years of teaching health information technology.
- 📈 The new guidelines and codes for evaluation and management (E/M) services are effective from January 2024.
- 🕒 Time reporting for E/M services has shifted from a range of minutes to a specific number of minutes, with exceptions for certain codes.
- 🏥 Office and outpatient services codes have been updated for 2024 to align with other codes, requiring a minimum time threshold to be met or exceeded.
- 💡 Telemedicine services must be equivalent to face-to-face services, with clear benefits such as facilitating diagnosis, reducing complications, and enhancing access to care.
- 🔄 Guidelines for coding multiple visits or encounters on the same day have been updated, specifying how to report services across different settings or levels of care.
- 👩⚕️ The time spent by a physician or other qualified healthcare professional can include assessment, management, counseling, and communication, summed together for coding purposes.
- 📌 For multiple encounters in the same facility, the guidelines state that the services must be provided by the same provider or different providers of the same specialty and subspecialty.
- 🏥 Inpatient observation care and nursing facility services have specific guidelines for reporting, which have not changed.
- 🔄 For split or shared visits, the code selection may be based on either time or medical decision-making, with the code reported by the provider who spent the majority of time or performed the substantive part of the medical decision-making.
- 🆕 A new add-on code, 99459, has been introduced for pelvic exams performed in conjunction with office or other outpatient, consultation, or preventive medicine codes.
Q & A
What are the new guidelines and codes for evaluation and management services effective from January 2024?
-The new guidelines and codes for evaluation and management (E/M) services effective from January 2024 include changes related to coding using time, guidelines for telemedicine services, coding multiple visits, US coding split and shared visits, hospital observation care, same-day admit and discharge, and one new add-on code 99459 for pelvic exam.
How has the timing for E/M codes changed for 2024?
-For 2024, the timing for E/M codes has changed to specific numbers of minutes from previous ranges. For example, office or other outpatient services codes now have a consistent format with other codes, and nursing facility times have been increased. The new code 99204 requires at least 45 minutes, and the time must be met or exceeded.
What are the guidelines for telemedicine services in the new E/M coding?
-The new guidelines for telemedicine services state that these services must be equivalent to face-to-face services. The benefits of telemedicine services include facilitating a diagnosis or treatment plan, potentially reducing complications and hospitalizations, and enhancing access to care, especially for rural or vulnerable patients.
How should multiple encounters on the same day be reported in the new E/M guidelines?
-For multiple encounters on the same day, the guidelines state that if the same provider sees a patient more than once, the time spent on each service should be reported separately without overlapping. The code selection can be based on either time or medical decision-making, and the total time spent providing each individual service can be allocated to the selected code level.
What is the significance of the new add-on code 99459 for pelvic exam?
-The new add-on code 99459 for pelvic exam is used in conjunction with office or other outpatient codes, consultation codes, and preventive medicine codes. It provides more specific information about the services rendered during the encounter, indicating that a pelvic exam was performed as part of the visit.
What are the requirements for reporting same-day admit and discharge codes under the new guidelines?
-To report same-day admit and discharge codes, the stay must be more than eight hours long, and the admission and discharge services must be provided by the same provider. The stay must include at least two visits, with at least one for admission and one for discharge.
What should be reported if a patient's stay is less than eight hours?
-If a patient's stay is less than eight hours, the new guidelines state that the provider should report only the initial hospital inpatient or observation care codes, without the discharge codes. The same-day admit and discharge codes should not be used.
How are split or shared visits defined and reported in the new E/M coding guidelines?
-Split or shared visits occur when two providers work together as a team to provide care for a patient during a single E/M service. The code selection may be based on either time or medical decision-making. The code is reported by the provider who spent the majority of face-to-face or non-face-to-face time performing the service, or by the provider who performed the substantive part of the medical decision-making.
What is the process for reporting codes when a patient is discharged from one facility and receives services from another facility?
-When a patient is discharged from one facility and receives services from another, the time spent in the discharge service for the first facility is not counted for time in the second service. The codes for each service should be reported separately, with the time spent in each service counted accordingly.
How can providers enhance the documentation of services in the outpatient setting?
-Providers can enhance the documentation of services in the outpatient setting by using specific codes that provide more detailed information about the services rendered. For example, the new add-on code 99459 for pelvic exam can be used with office or other outpatient codes, consultation codes, and preventive medicine codes to specify that a pelvic exam was part of the service.
What are the implications of the new E/M coding guidelines for medical practices and billing?
-The new E/M coding guidelines have significant implications for medical practices and billing. They require a more precise documentation of services, adherence to specific timing thresholds for coding, and careful tracking of encounters and services provided, especially in cases of telemedicine, multiple encounters, and split or shared visits. These changes aim to ensure that coding reflects the actual care provided and supports accurate reimbursement.
Outlines
📚 Introduction and Professional Background
Terry Tropen introduces himself and his qualifications, including a master's degree in healthcare administration and informatics, RHIA and CCSP certifications, and his role as an approved ICD10 trainer. He mentions his extensive teaching experience at Montgomery College and his authored books on coding, which are updated yearly and available on Amazon.
🕒 Changes in ENM Coding Related to Time
Terry discusses the changes in Evaluation and Management (ENM) coding based on time. He explains that codes previously listed in a range of minutes have been changed to specific minute counts. The exception was for office or other outpatient services codes, which for 2024 have been adjusted to align with the other codes. Additionally, nursing facility times have been increased. Terry emphasizes the importance of meeting or exceeding the minimum time threshold specified in the codes and provides examples to illustrate these changes.
📞 Guidelines for Telemedicine Services
New guidelines for reporting telemedicine services are introduced. Terry explains that many ENM services can be reported using telemedicine, which can be audio-only or audio and video interactions. He clarifies that the telemedicine service must be equivalent to a face-to-face service, and the benefits of telemedicine, such as facilitating diagnosis and treatment, reducing complications, and enhancing access to care, especially for rural or vulnerable patients, are highlighted. The guidelines also specify who can provide these services and how the time spent should be documented.
🏥 Guidelines for Multiple Encounters
Terry covers the guidelines for reporting services in multiple settings or encounters on the same calendar date. He differentiates between multiple encounters in the same facility, different settings or facilities, and same facility different levels of care. He provides detailed examples for each scenario, explaining how to report codes when services are provided by a single physician or different physicians, and how to handle situations where the level of care changes within the same facility.
🤝 Split or Shared Visits
The concept of split or shared visits is explained, where two providers collaborate to provide care for a patient during a single ENM service. Terry clarifies that code selection can be based on either time or medical decision-making. He provides examples to illustrate how to report codes when providers share a visit, and how to determine which provider's time or medical decision-making components should be used for code selection.
🏥 Inpatient Hospital Observation Care and Same Day Admission and Discharge
Terry discusses the updated guidelines for inpatient hospital observation care and same day admit and discharge scenarios. He explains that the stay must be more than eight hours, and the admission and discharge services must be provided by one provider, with at least two visits. He addresses what to do if the stay is less than eight hours and provides examples of how to report codes in different admission and discharge situations.
🆕 New ENM Code for 2024
Terry introduces a new add-on ENM code for 2024, 99459, for a pelvic exam listed separately in addition to the code for the primary procedure. He explains that this code is used with office or other outpatient codes, consultation codes, and preventive medicine codes to provide more specific information about the services rendered.
📧 Closing Remarks and Contact Information
Terry concludes the video by inviting viewers to contact him with questions or comments, providing his email address. He promotes his books available on Amazon and mentions his Facebook page for further resources. He also offers to send a PDF of the video slides to those who request it by emailing him.
Mindmap
Keywords
💡Evaluation and Management (E/M) Services
💡Coding
💡Telemedicine Services
💡Multiple Visits
💡Timing
💡Nursing Facilities
💡Inpatient Observation Care
💡Same Day Admission and Discharge
💡Split or Shared Visits
💡New ENM Code
Highlights
Introduction of new guidelines and codes for Evaluation and Management (E/M) services effective January 2024.
Terry Tropen's background as a healthcare expert with certifications and over 20 years of teaching experience.
Publication of updated books on E/M coding, ICD-10-CM, ICD-10-PCS, and changes for 2024.
Changes in E/M coding related to time reporting, with specific adjustments to office and nursing facility codes.
Clarification on the rounding of time spent during encounters, emphasizing that time can only be rounded down, not up.
Guidelines for who can provide services, including physicians and other qualified healthcare professionals.
Addition of a new section on telemedicine services, detailing the requirements for reporting and the benefits of telemedicine.
Guidelines for coding multiple encounters on the same day, including same facility, different settings, and different facilities.
Explanation of how to handle prolonged services, including the use of specific codes and the allocation of time spent.
Clarification on the reporting of services in different levels of care within the same facility, such as transfers between inpatient units.
Instructions on reporting services when a patient is discharged and readmitted to the same hospital on the same day.
New add-on code 99459 for pelvic exam, to be used in conjunction with office or other outpatient codes, consultation codes, and preventive medicine codes.
Emphasis on the importance of understanding and applying the new guidelines for accurate E/M coding.
Offer to provide a PDF of the slides for those who wish to have a copy, by emailing Terry Tropen.
Transcripts
5.0 / 5 (0 votes)
Thanks for rating: