How Do You Score Your Evaluation and Management Services?

Subscribers of eNews from First Coast Service Options Inc. (FCSO) the Medicare Fiscal Intermediary for Florida, Puerto Rico and the U.S. Virgin Islands were asked this question:

Do you find the E/M interactive tool useful?

The choice of answers listed was:

Yes
No
Don't have a need for it
Unaware of its existence

This made me start thinking about those answers, especially “Don't have a need for it” and how E/M services are “scored” and then coded to be submitted for payment. 

Almost everyone familiar with medical billing and coding has read through a CPT manual's section on E/M codes. To determine the level of the code, you are supposed to consider either the level of complexity or the extent of detail of the top 6 of the listed components. The seven components are:

History

Examination

Medical decision making

Counseling

Coordination of care

Nature of presenting problem

Time

For the person responsible for selecting the correct level of E/M service, it is easy to see with all of the elements to consider when choosing, this is a much more daunting task than it seems.

That is why an E/M score sheet is a great tool to enable the physician, a physician extender, or medical coder to quantitatively evaluate the service provided and assign the accurate E/M code representation. By using a scoring  system, it also helps to insure proper documentation in the medical record.

Some EHR software contain a scoring system, that keeps track of the components as they are entered in the medical record, providing the user with the recommended code once all documentation has been completed. This would obviously be the most convenient solution, but for those without this capability, FCSO offers this tool on their website for use by anyone, no website enrollment is required. The link is:

http://medicare.fcso.com/EM/165590.asp

By using E/M scoring in your practice you will have the benefit of coding to the highest applicable service level to generate the highest reimbursement and insuring proper documentation safeguarding against any chart audit recoupments.