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Unraveling the Mystery of E&M Codes

Properly documenting and reporting Current Procedural Terminology (CPT) codes is critical to being reimbursed fairly. Unfortunately, little time is dedicated to educating residents about coding and documentation. As a result, many physicians, especially those just beginning their careers, struggle with this crucial aspect of their practice.  Today’s session will focus on one of the more confusing sets of codes: evaluation and management (E&M) codes.

Lawrence M. Simon, MD, CPT

The session, which is intended for both academic and private practice physicians, as well as practice managers and staff, earned a repeat spot on the program after being one of the highest-rated sessions last year. 

“There’s a lot of confusion and misunderstanding over how to use these codes and what the terms in CMS’s guidelines for the codes mean,” said lead presenter Lawrence M. Simon, MD, CPT Advisor for the AAO-HNS, and assistant clinical professor of otolaryngology at Louisiana State University.

Dr. Simon and his co-presenter, James Lin, MD, AAO-HNS CPT Advisor Alternate from Kansas University Medical Center, will review the CMS billing guidelines for E&M codes and share how to properly use and document the codes. They will focus on four areas:

E&M Coding and Documentation for Proper Reimbursement

Today, 7:30 – 8:30 am

GWCC, Building A, Room 302

  • Patient history
  • Patient exam
  • Medical decision-making
  • Modifiers

“Medical decision-making is one of the more confusing coding aspects for physicians,” Dr. Simon said. While physicians have their own idea of what “medical decision-making” is, the CPT code set has a quantifiable definition. Attendees will learn how to objectively and universally determine if a decision is of low, moderate, or high complexity.

Physicians are also often confounded by modifiers, which are special codes that must be used in special circumstances, such as when a procedure is done in the office at the same time as an E&M service. Attendees will learn at-length how to properly use modifiers.

“CPT is the universal language of medicine,” Dr. Simon said. “It’s how doctors talk to hospitals, how doctors talk to payers, and it’s how they talk back to physicians. You have to understand the language in order to properly communicate what you’ve done and for the recipient to properly understand what you’ve done.”

The session will also cover many of the changes to the E&M reimbursement system being proposed by CMS. Drs. Simon and Lin will review the possible changes, their potential impact on the practice of otolaryngology, and the steps attendees can take to both stay informed and be part of the process. 

This session will be particularly beneficial to young physicians just starting out in practice. “You come out of your training knowing how to take care of patients but not knowing how to be properly paid for taking care of patients,” Dr. Simon said. “This is stuff that will be very, very important to their livelihood and for being able to support their family, grow their practice, and take care of their patients.”