User talk:Arun duraisamy

Hai, This is arun, i want to share my known knowledge to our peoples.

Billing process The medical billing process is an interaction between a health care provider and the insurance company (payer). '''CODING BASIC RULES '''

Evaluation and Management

Office visits – POS -11 A doctor's visit, also known as "physician office visit," is a meeting between a patient with a physician to get health advice or treatment for a symptom or condition.

New patients                         Established patients

99201                                       99211

99202                                       99212

99203                                       99213

99204                                       99214

99205                                       99215

Office consultation codes -POS – 11

Only for commercial insurances

New or Established

99241

99242

99243

99244

99245

Introduction and Definitions

The purpose of this entire website is to provide physicians with the tools they need to educate themselves about E/M coding and documentation. The fundamental principle of E/M University is that knowledge is power when it comes to E/M coding and documentation. Too many physicians are chronically undercoding for their services because they don’t understand the rules. A working knowledge of the E/M coding is the best way to ensure optimal compliance and avoid inadvertent undercoding. Physicians who understand the idiosyncratic process of E/M documentation can command a higher rate of return on their cognitive labor than their less E/M-savvy counterparts. In other words if you know how to accurately bill for your services, there is a better chance you will get paid for what you really do.

E/M stands for “evaluation and management”. E/M coding is the process by which physician-patient encounters are translated into five digit CPT codes to facilitate billing. CPT stands for “current procedural terminology.” These are the numeric codes which are submitted to insurers for payment. Every billable procedure has its own individual CPT code.

The CPT codes which describe physician-patient encounters are often referred to as “E/M codes”  There are different E/M codes for different types of encounters such as office visits or hospital visits. Within each type of encounter, there are different levels of care. For example, the 99214 code may be used to charge for an office visit with an established patient. There are five levels of care for this type of encounter. The 99214 code is often called a “level 4” office visit because the code ends in a “4” and also because it is the fourth “level of care” for that type of visit (with the 99215 being the fifth and highest level of care). Each patient care encounter may be viewed as a unique procedure which requires specific documentation.

The Key Components of E/M Documentation

The documentation for E/M services is based on three “key” components:

History

Physical Exam

Medical Decision-Making

E/M University Coding Tip: The key components are used to satisfy the documentation requirements for E/M coding UNLESS the physician is coding based on TIME. If time is the controlling factor, there are no specific documentation requirements for the three key components.

The E/M key components can be thought of as the building blocks of documentation for all patient encounters. Some types of encounters require complete documentation of all three key components, while others require only two out of three.

Office Consultation

99244- Requires that a letter be sent to the referring provider indicating the findings and suggesting a management approach.

New Patient Office Visit

99202,03,04,05- If counseling is more than 50% of the time spent then time determines the code. Document start time, ending time, and what was discussed. (see CPT requirements)

Established Patient Office Visit

99212,13,14,15- If the patient is already known to the practice this series of codes would apply

Typical Diagnoses (ICD-9-CM)

304.0 Opioid type dependence

305.7 Combination of opioid abuse with other