Evaluation

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Evaluation ManagementSelecting Levels of
Service

• Presented by
• Joan Benham, CPC, CPC-H
• Institutional Compliance Program

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E M Code Requirements

• Are not the same for all codes
• Have specific guidelines for their proper use
• Are very specific in nature

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Questions you should ask yourself .

• Where did the service take place?
• Does this service require all 3 key components?
• Is this service based on time?
• Who provided the service?
• Was this service documented?
• What is the nature of the presenting problem?

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Types of E M Codes based on place of service

• Out Patient
• In Patient
• Emergency Room

• Nursing Home
• Home
• Neonatal Intensive Care

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E M Services Requiring All 3 Key Components

• New Patient
• Initial In Patient
• Consults
• Emergency Room
• Observation
• Home

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E M Services Requiring 2 of 3 Key Components

• Follow-up
• Out Patient
• In Patient
• Consults
• Preventive Medicine

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Time Based E M Codes

• Counseling/Co-ordination of Care
• Critical Care
• Prolonged Services
• Physician Standby Services
• Care Plan Oversight
• Preventive Medicine Counseling
• Discharge Summary

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Non E M Visit Codes

• Psychiatry
• Ophthalmology

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Level of E M ServiceNew Patient
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Level of E M ServiceEstablished Patient
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Common Errors

• Selecting the wrong type of E M Code
• Selecting an E M based on 2/3 key components
  for a 3/3 key component code
• Insufficient documentation
• Time not documented

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Teaching Physician Involvement

• Stand alone
• With a resident
• After the resident
• Procedures
• www.the-medicare.com/ihs/docs/supervis.htm

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Remember when selecting a level of Service..

• Make sure you select the right type of E M code
• Know who provided the service(s)
• Make sure the documentation supports the level of
  service

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