Physician Assistant Professional Practice UNIT 2 Notes., Study Guides, Projects, Research of Health sciences

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3/15/25, 4:37 AM about:blank Physician Assistant Professional Practice UNIT 2 Notes Wk 4: Intro to Billing & Coding Regulations to focus on: Centers for Medicare and Medicaid Services ( CMS) Public Entitlement) Insurances Private Insurances Medicare & Medicaid Insurance plans provided administered by federal by employer, ‘government Evaluation and management DETERMINING WHICH (EIM) describes serviees you ‘CODE perm ring te pases = Wat nthe eing? = collecting HPL (Outpatient, hospital, ete.) = Istthe patient a new or established patient to the practice? ~ examining an abdomen + creating a plan of care henson te ee it EM CP Ieetnation & uanag codes for outpatient and EN oor meneement inpatient services. We'll focus subset of CPT codes ou Services ‘New guidelines rely on medical decision making (MDM) and/or time spent to determine level of service in order to decide with E/M CPT code to use to submit for the claim (bill of charges) to Medicare Simplified guidelines do not require all components of H&P ‘exam to be documented (aka the above 7 items) ‘NEW PATIENT E/M CODE REQUIREMENTS Example: We see patient in clinic for acute diarthea & abdominal cramping, You do focused H&P, and dx of IBS w/ diarrhea (K58.0) was made. MDM as low (new flare-up of existing condition, familiar presentation, no red flag sx) and document 34 min total time on this patient visit. Using MDM and time, the E/M code selected was 99203 ‘Outpatient setting: Clinics are CHCs are (almost all) not designated as hospital designated as Federally settings Qualified Health Centers Place of Service (POS) (EQHCs) — CMS designated as codes : designation codes POS 50. that CMS has created for different settings that aPA Traditional physician office: or other healthcare POS 11 practitioner may evaluate & ‘manage patients KEY COMPONENTS FOR E/M SERVICES. HPI Physical Exam Medical Decision Making CONTRIBUTING COMPONENTS Additional components factored into equation Counseling Coordination of care ‘Nature of presenting problem Time ‘These 7 components help demonstrate through documentation ‘what occurred during the patient encounter & support determining the level of service CMS differentiates new & established patients ofthe group practice ‘New patient Established patient A patient who has not ‘A patient who has received received professional services _professional services by any bby aphysician or other physician or qualified qualified member (PA or NP) __ member of the group practice of the same group practice ‘within the past 3 years within the past 3 years ESTABLISHED PATIENT E/M CODE REQUIREMENTS 1/19