Wiki ENT/Allergy

[dvmckinney916]

This question is in regards for an ENT Allergy practice. If we bill a level 3,4, or 5 consult and new patient E&M, does it require vitals in order to bill compliantly?

 

[JenniferB7]

While CPT does not specifically address vital signs , most coders/auditors defer to the 1995 and 1997 E/M guidelines published by CMS when leveling E/M services.

In short, to answer you question, vital signs would be a required element to bill a level 5 consult or new patient E/M. Whether you choose to use the general multi-system exam or ENT single organ system exam, you cannot meet the requirements for a comprehensive medical exam without documentation of vital signs. You can however, meet the requirements for a level 3 or level 4 consult or new patient E/M without vital signs. It is helpful to reference the 1995 and 1997 E/M guidelines on the Medicare website (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf). It is a bit of read, but it is very helpful when it comes to determining the appropriate level of E/M service.

Hope that helps,

Jennifer M. Connell, CPC, CPCO, CPC-P, CPB, CPMA, CPPM, CPC-I, CENTC