| Are you bogged down with Evaluation & | | | | medical family and social/or social history (PFSH). |
| Management codes history of present illness (HPI), | | | | Does the exam fail carrier’s requirements? |
| review of systems (ROS), and exam elements? | | | | If you don’t meet your carrier’s definition of |
| Financially, you’re better off with eye codes rather | | | | “immediate” or “comprehensive” eye |
| than E/M services provided of course documentation | | | | exams, you should go for an E/M service code |
| supports choosing this code. But the following situations | | | | instead of an eye code. |
| will help you ditch eye codes in favor of evaluation | | | | Is the patient’s problem resolving? |
| &management codes. | | | | Be careful of using only eye codes if providing |
| To focus on the correct code set, mark these | | | | comprehensive ophthalmic services that encompass |
| differences so that you don’t miss out on the | | | | evaluating resolved or resolving conditions that are |
| reimbursements. | | | | very straightforward in nature. An E/M code might be |
| Does documentation contain the first three key | | | | the right choice, when documentation describes |
| components of E/M i.e. history, examination, and | | | | follow-up of known, straightforward or resolving |
| medical decision making (HEM)? | | | | problems, consultations or hospital services. |
| Evaluation & management codes have national | | | | Does the visit qualify for time-based billing? |
| coding guidelines that detail the documentation | | | | You can use evaluation & management codes |
| necessary to support a given level of service. The | | | | for counseling-based visits. When counseling and/or |
| guidelines describe each service level’s national | | | | coordination of care dominates more than half the time |
| Medicare required amount of HEM. Only medically | | | | spent face to face with the patient by the physician, |
| necessary performed and documented items count | | | | coding guidelines allow you to assign E/M code based |
| toward an area. Eye codes do not have those (HEM) | | | | on the time indicated in the E/M code’s description. |
| requirements and are not subject to mandatory | | | | To get access to more of such articles and give more |
| auditing. | | | | bones to your evaluation and management coding, |
| Does the note contain enough history? | | | | there are one-stop medical coding websites where |
| When determining a service’s history level using a | | | | you can turn to and explore the range of articles they |
| standard audit tool, count all medically necessary | | | | have on offer. |
| elements of HPI, review of systems ROS, and past | | | | |