Prescription Drug Management in E&M Services Does Not Mean a Level 4 Procedure Code
Changes in E&M coding are important to go over including information regarding prescription drugs. This week’s coding conundrum goes over the parts of the table of risk and medical decision making. Read below to find out more!nnAs 2021 approaches and we think about the changes to evaluation & management (E&M) coding it’s more important than ever to really spend some time to break down what medical decision making (MDM) means and how to assign the correct level.nnMDM consists of 3 individual parts, but often it’s only the table of risk that is considered in choosing a level. Like for instance that if you write a prescription that is an automatic level 4. Wrong!nnIn the example of an established patient with well-controlled hypertension and allergies, they are at the clinic for a routine follow-up and prescription refill. They are feeling well with no other complaints. You review their most recent lab work which is within normal limits, write a prescription for the refill and the patient agrees to follow-up again in 6 months. This would be coded to a level 3, 99213, E&M visit.nnTo break it down, MDM part A would equal two, two stable established problems. MDM part B would equal one, review of lab work. And MDM part C would be of moderate risk for two stable chronic problems and prescription drug management.nnBased on our guidelines in CPT; “To qualify for a given type of decision making, two of three elements in Table 1 must be met or exceeded”. Below is a copy of the table referenced.nn
Table taken from an article by AAFP
The Welter Healthcare Partners team is closely monitoring the payer updates for telehealth as they continue to unfold. Please do not hesitate to contact us if you have any coding or billing issues. Below is updated information regarding COVID-19 Telehealth and billing updates. 
Summer is here and many people are spending more time outside, swimming and taking vacations. It is very important to wear your sunscreen to protect yourself from the sun. Read below for more information from the American Academy of Dermatology about the importance of sunscreen!nnWith the “Official start of summer” (a.k.a Memorial Day) officially past and the reopening of many beloved outdoor activities after the shutdown from COVID-19, it’s more important than ever to remember your sunscreen.nnEspecially after so many of us just spent months indoors. The American Academy of Dermatology (AAD) has a great two-minute video as well as 5 tips for proper sun protection.nnSo get outside, enjoy your favorite activities, and do not forget to apply that sunscreen, it’s finally summer!nn
The number of people using telehealth has grown tremendously since the COVID-19 outbreak. Many patients are equally satisfied with virtual encounters rather than their in-person visits to the doctor. Read the article below for more on the survey given to patients regarding telemedicine and what they preferred about their virtual visit.nnThe advent of COVID-19 has fueled the rise of telemedicine, accelerating growth beyond what was even imaginable only three months ago. Along with this phenomenon, a related mystery has been seemingly solved: can patients be as satisfied with virtual interactions as they are with in-person encounters?nnAccording to a new, large-scale Press Ganey survey, that answer is yes. The South Bend, Indiana-based company, known for its patient satisfaction surveys, took a deep look into comparing the two forms of provider-patient interactions and found that “virtual visits can achieve similar ratings for patient experience as in-person visits, with some specific differences in methods of care delivery,” according to a news release.nn“The rapid adoption of telehealth has enabled caregivers to meet the needs of patients with the levels of attentiveness, expertise, and empathy provided during an in-office visit,” said Patrick T. Ryan, chairman, and CEO of Press Ganey. “If caregivers actively adapt their processes and behaviors to the telemedicine environment, they can effectively build the unbreakable bonds of trust that are so critical to patient-centered care.”nnThe survey was conducted over a six-week period concluding at the end of April and includes more than 30,000 responses. During that time respondents reported nearly 70% of their encounters involved a full or mixed virtual medicine component. Mixed visits could have included a combination of video and in-person visits, telephone, email, or text.nn”Based on the data, patients are overwhelmingly positive about their virtual interactions with their care providers, even when technical issues posed challenges,” according to The Rapid Transition to Telemedicine: Insights and Early Trends, issued by Press Ganey. A chart in the report demonstrates tight alignment between patient’s satisfaction scores for virtual or in-person visits when asked about their likelihood of recommending care provider, the provider’s concerns for their questions or worries, efforts to include them in decisions, explanations of problems and conditions, treatment discussions, and “whether the staff worked together to care for you.”nnThe survey also indicates, however, opportunities to improve processes related to telemedicine. For example, ease of scheduling appointments and ease of contacting the provider scored much lower for virtual care versus in-office visits. As a result, patients are less likely to recommend virtual visits to others compared to office encounters.nn”This is not unexpected given the quick, large-scale transition to telemedicine and the learning curve for the provider and the patient,” the report states. “These data highlight opportunities for enhancing the physician-patient connection by addressing technical barriers that impede consistent and reliable communication.”nnThe report suggests several recommendations to help providers enhance the patient experience when conducting virtual visits:n
This week’s code spotlight highlights the social determinants of health codes that deal with many factors including prescribed medications or a patient’s BMI. Read below for more information on some of the benefits of including social determinants of health in reporting.nnAs the health care industry sees an increase of risk adjustment coding, the importance of correct and accurate ICD-10 coding is continuing to be an area of discussion among the various organizations. Although these codes do not carry an HCC level, from a correct coding standpoint, it is always important to code to the greatest specificity supported by the documentation. Social determinants of health (SDoH) category codes of Z55-Z65 are part of Chapter 21 [Factors Influencing Health Status and Contact with Health Services] which all deal with a wide range of factors from prescribed medications to a patients BMI. As coders, it’s important to not forget to report these codes if they are supported by the documentation. As clinicians, it is important to make sure that these factors are documented when present.nnIn a November 2019 article posted on the American Medical Associations website (