Evaluation and Management Coding is Manageable

March 3rd, 2017 - Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP
Categories:   Evaluation & Management (E/M)  
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As a chiropractor, we use E/M codes frequently, but not at every encounter, as do our medical counterparts.  These are the CPT codes used to describe the work involved in figuring out what is wrong with a patient and creating a plan to manage them.  One of my good friends, Dr. Mario Fucinari, told me that he explains that chiropractic care is like a loaf of bread.  The heels are the initial evaluation and the discharge evaluation.  All of the slices in between are the treatment visits.  Depending upon the duration of the care plan, you might insert a few update evaluations in amongst the slices as well.  If those occasions are significant and separately identifiable from the chiropractic manipulative treatment, an E/M code would be billed then. 

E/M codes have all kinds of rules and components.  They can be difficult to understand, especially if you want to spend your time working on your patients rather than coding and documentation.  Fortunately, Dr. Gwilliam has waded through all the information out there and compressed into chiro-specific training. You can view in the Video DeskBook that is part of Premium Membership, or purchase it separately here.  It follows a simple, full color, two-sided card that you can get for just $29 here.  On March 21st, 2017, you can also get a taste of the training at our free webinar.  In the meantime, here are a few random tips to whet your E/M appetite:

  • If you don’t document a Review of Systems, the highest Evaluation and Management code you can use is 99201 (or 99213 for established patients).
  • If you neglect to document Past, Family, and Social History, the highest E/M code you can use is 99202 (or 99214 for established patients).
  • Chiropractors should rarely, if ever, bill for high level codes such as 99204, and 99215.  This is primarily because we do not see patients with a high enough type of Medical Decision Making based on the risk of morbidity and/or mortality. 
  • Chiropractors should rarely, if ever, bill 99211 (aka the Nurses Code) because the work is almost always included in other codes we bill.  If we are indeed performing an evaluation, then we should consider the 99212 because the criteria are very easy to satisfy.
  • If you have a written request for an evaluation from an appropriate source, and you send the patient back to the source with a written report, you can bill for the more highly paid Consultation E/M code. 

There is a lot more to know, but at ChiroCode we have whittled it down to what really matters for DCs.  We are here to help. 


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