Clear Your Confusion with these CPT Coding Guidelines

Published: 18th May 2009
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You've probably had it up to here with trying to understand Medicare and CPT coding guidelines for E/M. But now you can assign an office visits' elements with confidence if you follow the advice offered by CMS and coding experts.

When a physician orders a diagnostic test, such as a colonoscopy, the patient refuses to undergo the test - it creates confusion whether the physician is supposed to get credit for the order when determining the level of complexity associated with the encounter. The CPT coding guidelines state that you should factor the physician's order into the medical decision-making or care/treatment plan. Be sure you document that the physician ordered the test; the patient refused it and why he did so.

The physician's decision to order a diagnostic test impacts each of the medical decision-making section's three elements. Factoring in the physician's order makes sense because if the physician went through the medical decision-making process to determine that the patient needed a particular test, even though the patient didn't follow through. Get it clear - there was work involved on the part of the physician.

Take this scenario: An audit tool awards two credits for independent visualization of an image, tracing or specimen itself - not simply review of a report. The tool also awards one credit for ordering a diagnostic test. Now, if the physician ordered a test and he personally reviewed the tracing on the same day, it creates confusion whether the physician would be awarded credit for both the order and the personal review. The CPT medical coding guidelines say that the physician may be awarded credits for both, as they are separate activities.

If you do review the diagnostic test or look at it in a scope and make judgments, then documenting this activity should allow you to have credit for both ordering and reviewing it. This clarification is huge for physicians who personally review their own diagnostic testing.

Use these CPT coding guidelines for both the scenarios will help you report correct evaluation and management levels and make sure you get the reimbursement for your office - every time.

We also provide medical billing and medical coding audio conferences with premier coding experts, CDs, tapes and transcripts of coding training information by specialty.

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