The FY 2011 Office of the Inspector General Work Plan contains two issues that professional fee coders should be concerned about. Correct coding of E/M services based on the guidelines and E/M services during global surgery periods are ongoing issues.

Certainly the implementation of an annual wellness visit for Medicare beneficiaries is a step in the right direction; however,it does not necessarily solve the problem of problems encountered during the visit. I bring this up as most of my primary care clients will agree that it’s a rare occasion where a Medicare beneficiary is scheduling for a true “preventative visit”. Typically, this is a visit to follow-up on old problems and most commonly a host of new issues. Under the PPPS requirements, the annual wellness visit includes at a minimum the fol

Having trouble using the most recent Part B Utilization data file from CMS? You’re not alone. Lots of people are upset about the non-friendly .pdf version of the file this year. The gurus at Wolters-Kluwer heard your concerns and converted the file to the Excel format for easier use.

Hospitals have been struggling since the inception of the Outpatient Prospective Payment System (OPPS) back in 2000 with CMS’s instructions for hospitals to develop internal hospital guidelines to determine what level of visit to report for each patient. General guidelines have been provided over the course of the last 10 years such as:

Medical Decision Making (MDM) is one of the three “key components” of determining the level of an evaluation and management (E/M) service. It is probably the most difficult component of an E/M service to review. MDM is where the providers thought process is quantified and most often the primary role in determining the correct level of service or E/M code.

In a previous blog I wrote, "Seeing the “Gray” in Evaluation and Management Coding – Chief Complaint and History of Present Illness," I had started a dialogue related to Chief Complaint (CC) and History of Present Illness (HPI) gray areas. In this edition I hope to continue the conversation as it relates to review of systems (ROS) and past family social history (PFSH).

Many health care professionals use E&M coding grids to assist with the application of E&M codes. In it’s Evaluation and Management Services Guide, CMS indicates that for determining the complexity of medical decision making, “The number of possible diagnoses and/or the number of management options that must be considered is based on: