Practice Management Alert

Evaluation and management services represent the bulk of what most practices bill these days. So if your E/M coding knowledge isn't up to snuff, your practice could be missing out on major reimbursement or risking compliance issues.

Find out if you-re properly billing the E/M services your physicians perform with these five quiz questions. Watch for the answers in the next issue of Medical Office Billing & Collections Alert.

Question 1: The physician puts an asthma patient on steroids and changes his inhaler settings after an exacerbation. The patient returns the next week for a scheduled follow-up. The provider asks the patient if he is having any breathing trouble since his medication change. What review of systems (ROS) level does this represent?

A. Problem-pertinent ROS
B. Extended ROS
C. Complete ROS
D. None of the above.

Question 2: A patient who is new to the area makes an appointment with the physician for a yearly physical and to discuss chronic diagnoses of asthma and depression. The physician performs the preventive medicine service and has a long discussion with the patient regarding the chronic diagnoses. The documentation supports the annual physical code and also has enough stand-alone documentation to bill an E/M with the visit. Which of the following should you bill?

A. New patient physical only.
B. Established patient physical only.
C. A new patient physical with the appropriate-level new patient E/M.
D. A new patient physical with the appropriate-level established patient E/M.

Question 3: Your physician sees an established five-year-old patient with severe chronic allergies. The patient is not presenting with any symptoms currently. Your physician documents a detailed history, a detailed exam, and low complexity decision making. You can report 99214.

A. True.
B. False.

Question 4: A patient comes into your practice in the morning for some lab draws and an echocardiogram. Later the same day the patient comes back and sees another physician (in the same specialty) for coordination of care based on the findings. How would you report these services?

A. Report a separate E/M code for each visit.
B. Report just one E/M code that represents the combined service levels of both visits.
C. Report just one E/M code, ignoring the second visit all together.
D. None of the above.

Question 5: The physician sees a former patient who was in an automobile accident. The physician does a comprehensive history and examination and documents medical decision-making. The E/M medical necessity level meets the criteria for 99214. The physician spends additional time answering the patient's many questions and helping her to understand her options. The total visit takes 60 minutes. What code(s) should you report?

 A. 99214
 B. 99214-21
 C. 99214, 99354
 D. 99354.