Preventive Services And E/m Coding Requirements – Some Helpful Tips

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Many of the preventive service codes that have been introduced by the CMS over the past two years have time requirements, so it is important to document the time spent on these services.



Many of the preventive service codes that have been introduced by the CMS over the past two years have time requirements, so it is important to document the time spent on these services. Remember that when reporting preventive services on the same day as an E/M service, you need to attach the appropriate modifier to avoid overlapping of the services. Modifier 59 has to be appended for a distinct procedural service and Modifier 25 for a significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service. It is important to record that you performed both procedures separately and that they were medically necessary.

There are certain time-based preventive service codes such as that for behavior therapy to reduce cardiovascular risk (G0446) that do not require documentation of time spent. However, it is best to make a record of the time spent for such services also, ...
... because in case of an audit, you will have to justify the use of this code.
The Medicare eligibility screen usually doesn’t notify providers when an annual screening has taken place. However, you will be given information about the next suitable date when the service can be performed.

Medical Decision Making Made Simple for E/M



To arrive at the correct level of Medical Decision Making (MDM) points have to be assigned to each of the three components the physician performs. According to Suzan Berman, CPC, CEMC, CEDC, Senior Director of Physician Services at Healthcare Revenue Assurance Associates based out of Plantation, Florida, the three components that add complexity to the physician’s decision making process are “diagnoses/management options, complexity of data reviewed/ordered, and the table of risk.” Two out of these three components have to score at a particular level in order to assign that level of MDM. The MDM score is ‘moderate’ if the number of diagnoses is low but the complexity and amount of data as well as the level of risk are both moderate. Another way to arrive at the correct level of MDM is to eliminate the lowest and highest scores; the remaining score will be the MDM level.

Have a clear idea of each level of diagnosis and for each diagnosis assign a point. For a self limited/minor problem you can assign one point each, up to a maximum of two points. For an established problem, improving/stable assign one point each. If the problem is established/worsening assign 2 points each; if the problem is a new one with no planned additional workup, assign 3 points each up to a maximum of 3 points; for a new problem, additional workup assign four points each.
Consider the amount and complexity of the medical encounter data. The complexity has to be scored in the same manner as the diagnoses, i.e. minimal (0-1); low/limited (2); moderate (3); and high (4+)
The level of risk is difficult to determine. It comprises three subcategories. These are presenting problem, diagnostic procedures ordered and management options. The patient’s risk level is determined as minimal, low, moderate or high based on the highest score from only one of the three categories, not from each category.

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Outsource Strategies International (OSI) offers medical billing services, focusing on every aspect of the medical billing / patient cycle. OSI also offers medical billing and coding services for clients to ensure timely reimbursement, ultimately affecting their bottom line and cash flow.

Outsource Strategies International (OSI) provides medical billing & coding, dental billing & coding, insurance & eligibility verifications to medical and dental practices.