May 6, 2011 by dailybolusoflr
Billing and Coding Overview
· The E/M codes or Evaluation/Management Codes are 5 digit codes which are assigned to the patient’s visit.
· The Levels indicate the wide variations in skill, time, effort and resources required to diagnose and treat any particular patient
· They are incremental and go up from 1 through 5. The Level 5 patient is a more complex patient. Some examples are provided below.
o 99281 (a billing level 1 patient) – A medical refill, a tetanus shot, a wound check
o 99282 (a billing level 2 patient) – Conjunctivitis, minor injury or complaint. . NOT requiring slit lamp/xray/labs etc
o 99283 (a billing level 3 patient) – Conj abrasion with slit lamp, injury with single area imaged, UTI w UA, HA no CT, Gyn with exam
o 99284 (a billing level 4 patient) – HA with imaging, pyelo goes home, MVC wo injury found, asthma w tx goes home
o 99285 (a billing level 5 patient) – Suspected/confirmed CHF, COPD, PNA, Meningitis etc and others requiring IV meds, extensive eval
o There are THREE key components to the E/M level codes.
§ History Level
§ Examination Level
§ Medical Decision Making (MDM) Level
o The chart is billable only to the highest level of documentation that is met by all THREE components. Thus, if you do a great history and examination which meets highest level 5 billing requirements and document a low level medical decision making, your chart will only be billed at the highest level they can meet based on your lowest level of documentation. This translates to lost revenue.
We will discuss each of these key components in detail in future Bolus emails.
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions
1830 East Monument Street
Baltimore, MD 21287