Health Information Management

Tip: Use CMS guidelines when creating E/M level

APCs Insider, September 14, 2012

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

CMS has not created national guidelines for determining an E/M service visit level, instead requiring each facility to create its own internal guidelines. However, CMS does offer some general advice. According to the agency, E/M level guidelines should:

 
1.  Follow the intent of the CPT® code descriptors in that the guidelines should be designed to reasonably relate the intensity of hospital resources to the different levels of ­effort represented by each code
2. Be based on hospital facility resources, not physician resources
3. Be clear, to facilitate accurate payments and enable use for compliance purposes and audits
4. Meet HIPAA requirements
5. Only require documentation that is clinically necessary for patient care
6. Not facilitate upcoding or gaming
7. Be written
8. Be applied consistently across patients in the clinic or ED to which they apply
9.  Not change with great frequency
10. Be readily available for FI (or, if applicable, MAC) review
11. Result in coding decisions that are verifiable by other hospital staff, as well as outside sources

 

The tip is adapted from “Factor in appropriate resources for ED E/M criteria” in the August Briefings on APCs.



Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Most Popular