CMS vs. CPT® E/M Coding Requirements and Payer Considerations and Admissions and Transfers Case Level Severity Review

Presented by: Dr. John Stimler, DO, CPC, CHC, FACEP
Total Run Time: 1:37:11
AAPC Approved for 1.5 CEUs, Core A, and all specialties except CIRCC and CASCC Specialty Credits

CMS vs. CPT E/M Coding Requirements and Considerations
There are notable differences in the CMS and CPT documentation requirements that influence code choice depending on the payer. Understanding these differences is crucial to proper E/M code choice.

Topics include:
• CPT Documentation Guidelines and History, Exam, and MDM.
• CMS Documentation Guidelines and how they are different.
• CMS vs. CPT Guideline differences and how they impact E/M code choice 99281 – 99291 CMS vs. CPT Procedure Code differences.

The Significance of Admissions and Transfers
Admissions and transfers are common in the practice of emergency medicine. Does admission to the hospital, or transfer to another facility, usually generate a Level Five or Critical Care code choice? While many admitted and transferred cases represent high acuity, high severity patients, there are some that are commonly coded at Level Four.

Topics include:
• Examples of high severity cases that carry an immediate threat to life or bodily function yet still generate minimal ancillary studies and minimal therapy.
• Patient complaints and objective criteria that often generate Level Five code choice.
• Examples of admitted/transferred cases that are frequently coded at Level Four.

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