Use of the Medicare Audit Tool and An Introduction to Objective Criteria for Emergency Medicine E/M Code Choice – Part 1

Presented by: Dr. John Stimler, DO, CPC, CHC, FACEP
Total Run Time: 1:31:47
AAPC Approved for 1.5 CEUs and/or CEDC, CPCO and CPMA Specialty Credits

Online Test

The original “Marshfield Clinic Audit Tool” and the current “Medicare Documentation Worksheet” that are sometimes used by emergency medicine coding organizations were originally developed for use by multi-specialty clinics and office-based medical practices, and not for the practice of emergency medicine.

In collecting and evaluating E/M code distribution data over twenty years of work as external coding auditors, we witnessed the significant variance in E/M code choice that existed between peer companies who were all working to ensure proper reimbursement for provider professional services. Even given this collective goal, E/M code choice was being driven by policy and criteria that was highly subjective from organization to organization, and often based on opinions about the perceived severity or complexity of case types.

BSA Healthcare’s physician consultants felt that it was necessary to formulate objective criteria in E/M code choice based not only on the levels of history and exam in encounters, but also on the complexity of Medical Decision Making (MDM). Utilization of fine-tuned objective criteria has resulted in more consistency in E/M code choice across the industry.

Hosted by Dr. John Stimler, Managing Member of BSA Healthcare, this three-part webinar series will teach coders, compliance personnel, reimbursement directors, and providers how to properly interpret and utilize objective criteria and the Medicare Audit Tool for emergency medicine E/M coding.

Part One of this three-part series addresses the following topics:
• Medicare audit tool and E/M code choice
• Tables A, B, and C (Risk Table)
• Subjective vs. objective criteria
• Introduction to objective criteria for E/M code choice.