Codapedia: Category of Code Selection

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General

Author:
Codapedia Editor

Category of Code Selection
Citations:	No citations found
Resources:	Category of Code Selection (pdf)

Total Reviews: 5

Current Rating: ••••••••••

Does anyone remember the good old days, when you didn't need to know the patient's insurance to select a category of code? Now, correct selection of an E/M category of code requires the clinician and coder to consider:

Where the service was performed
The status of the patient (Observation vs inpatient vs ED patient)
Whether the patient self referred, was sent for an opinion
Is new or estabilshed

This article has a one page pdf file attached to help with the decision making process. For any insurances that follow Medicare rules on consults, select the category of code as if they were Medicare patients when using this chart.

Printable Version

Cloned E/M notes

OIG Work Plan 2012

Medical Necessity is not Medical Decision Making

New ABN form mandatory Nov 2011

Three-day Window Rule

Medicare Wellness Visits--update

Medicare Secondary Payer

Doing--and coding--for minor procedures in primary care

Subsequent Observation Services

Wellness visits for Medicare patients

Click Here to Comment, Clarify and Rate this Article

Codapedia Editor Thu, Jul/07/2011	category of code I have the Professional Edition, and don't see any changes from previous years. It instructs us to use 99201--99215 in the office or outpatient department, and 99281--99285 for services provided by physician in the ED. The Medicare Manual says this (Pub 100-04, Chapter 12, Section 30.6.11C Use of Emergency Department Codes to Bill Nonemergency services. Services in the emergency department may not be emergencies. however teh codes (99281--99288) are payable if the described services are provided. However, if the physician asks the patient to meet him or her in the emergency department as an alternative to the physician's office and the patient is not registered as a patient in the emergency department, the physician should bill the appropriate office/outpatient codes. Normally a lower level emergency department code would be reported for a nonemergency condition. So, it looks like the status of the patient (registered or not registered in the ED) will determine the category of code.
LindaLou Thu, Jul/07/2011 Ratings: •••••	New guideline? I have heard that on the 2011 expert CPT® book there is a notation stating that outpatient codes 99201-99215 "exclude services provided in the ED" and direct you to use an ED code. This conflicts with the handout within this article, and I am wondering if anyone knows anything about this??
Codapedia Editor Thu, Jan/13/2011	The chart is next to the word resource Click on the words "Category of Code" to the right of the word resource. Kim, thanks for the kind words.
jschmutz Thu, Jan/13/2011 Ratings: •••••	attachment? Where is the attached pdf that the article is referring to?
KPollock Wed, Jan/12/2011 Ratings: •••••	Category of Code Selection As always, Betsy has a great way of explaining complicated issues and making them simple!