Billing: Difference between revisions
(Added Physical Exam and ROS) |
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**Marital Status | **Marital Status | ||
**Sexual History | **Sexual History | ||
===Review of Systems=== | |||
There are 14 organ systems recognized by CMS:<ref>https://efficientmd.com/a-simplified-explanation-of-emergency-department-e-m-coding/</ref> | |||
*Constitutional | |||
*Eyes | |||
*Ears, Nose, Mouth and Throat | |||
*Cardiovascular | |||
*Respiratory | |||
*Gastrointestinal | |||
*Musculoskeletal | |||
*Integumentary (skin and/or breast) | |||
*Neurologic | |||
*Psychiatric | |||
*Endocrine | |||
*Hematologic/Lymphatic | |||
*Allergic/Immunologic | |||
===Physical Exam=== | |||
CMS recognizes the following 14 systems as part of the physical exam:<ref>https://efficientmd.com/a-simplified-explanation-of-emergency-department-e-m-coding/</ref> | |||
*Constitutional | |||
*Eyes | |||
*Ears, Nose, Mouth and Throat | |||
*Neck | |||
*Respiratory | |||
*Cardiovascular | |||
*Chest (Breasts) | |||
*Gastrointestinal | |||
*Genitourinary | |||
*Lymphatic | |||
*Musculoskeletal | |||
*Skin | |||
*Neurologic | |||
*Psychiatric | |||
==RVU For Level of Service<ref>http://www.acep.org/Clinical---Practice-Management/Top-20-ED-Reimbursement-Codes-2016/</ref>== | ==RVU For Level of Service<ref>http://www.acep.org/Clinical---Practice-Management/Top-20-ED-Reimbursement-Codes-2016/</ref>== | ||
Revision as of 06:03, 30 December 2018
CMS Requirements for Billing
| 99281 | 99282 | 99283 | 99284 | 99285 | |
| Level1 | Level 2 | Level 3 | Level 4 | Level 5 | |
| HPI | 1 of 8 | 1 of 8 | 1 of 8 | 4 of 8 | 4 of 8 |
| ROS | 0 | 1 | 1 | 2 | 10 |
| PMHx, FamHx, Social Hx | 0 | 0 | 0 | 1 | 2 |
| PE | 1 | 2 | 2 | 5 | 8 |
| MDM | Straight‐forward | Low Complexity | Moderate Complexity | Moderate Complexity | High Complexity |
History of Present Present Illness Illness (HPI)
- Location
- Severity
- Timing
- Modifying Factors
- Associated Associated Signs and Symptoms Symptoms
- Onset
- Quality
- Duration
Past Medical, Family, Family, Social History
- Past Medical
- Past Illnesses
- Major Injuries
- Surgical History
- Hospitalizations
- Immunizations
- Feeding/Dietary
- Family History
- Health Status
- Deaths
- Hereditary Diseases
- Social History
- Drug, etoh , tobacco
- Employment
- Marital Status
- Sexual History
Review of Systems
There are 14 organ systems recognized by CMS:[1]
- Constitutional
- Eyes
- Ears, Nose, Mouth and Throat
- Cardiovascular
- Respiratory
- Gastrointestinal
- Musculoskeletal
- Integumentary (skin and/or breast)
- Neurologic
- Psychiatric
- Endocrine
- Hematologic/Lymphatic
- Allergic/Immunologic
Physical Exam
CMS recognizes the following 14 systems as part of the physical exam:[2]
- Constitutional
- Eyes
- Ears, Nose, Mouth and Throat
- Neck
- Respiratory
- Cardiovascular
- Chest (Breasts)
- Gastrointestinal
- Genitourinary
- Lymphatic
- Musculoskeletal
- Skin
- Neurologic
- Psychiatric
RVU For Level of Service[3]
- 99281 (Level 1) = 0.60 RVUs
- 99282 (Level 2) = 1.17 RVUs
- 99283 (Level 3) = 1.75 RVUs
- 99284 (Level 4) = 3.32 RVUs
- 99285 (Level 5) = 4.90 RVUs
- 99291 (Critical Care) = 6.31 RVUs 1st hr
- Critical Critical care can be coded when the total duration duration of time spent by a provider in providing critical care services to a critically ill or critically injured patient is at least 30 minutes, even if the time spent is not continuous.