Transcript Presentation - AHS - American Headache Society

Webcast Session I
An Introduction to Evaluation and Management (EM) Coding
Accurate Coding for Evaluation and Management (EM) Services
A webcast designed for headache and migraine specialists
Presenters
Stuart B. Black, MD
American Headache Society (AHS)
Sheila J. Madhani, MA, MPH, CCS-P
MARC Associates
October 9, 2007
Goals
• Introduction to CPT EM codes
• Review of CPT coding guidelines and
practices
• Application of CPT coding guidelines and
practices to clinical scenarios relevant to
headache specialists
What Will We Discuss?
•
•
•
•
•
Importance of accurate coding
CPT codes vs. ICD codes
Components of EM codes
Types of EM codes
How to properly select and report EM
codes/services
• Use of modifiers
• Clinical examples
• Coding resources
Importance of Accurate Coding
• Full and fair description of services
provided
• Avoid over-coding (fraud and abuse) and
under-coding (not reporting all the services
you have provided)
• Improve quality of patient care
CPT codes vs. ICD codes
CPT codes vs. ICD codes
• CPT codes
– CPT is an acronym for Current Procedural Terminology
– CPT codes are published by the American Medical Association and are
used by CMS and many private insurers to report physician services
– A CPT code is a five digit numeric code that is used to describe
medical, surgical, radiology, laboratory, anesthesiology, and
evaluation/management services
– There are approximately 7,800 CPT codes ranging from 00100 through
99602
– Two digit modifiers may be appended when appropriate to clarify or
modify the description of the procedure
CPT codes vs. ICD codes
• ICD
– ICD stands for International Classification of
Diseases
– It is a coding system used to code signs,
symptoms, injuries, diseases, and conditions
CPT codes vs. ICD codes
• Relationship between CPT and ICD
– Both types of codes must be reported on
claims to Medicare and many private insurers
– CPT code
• Describes medical procedure or service
– ICD code
• Describes clinical condition of patient to support
the medical necessity of the procedure or service
CPT codes vs. ICD codes
• ICD-9-CM
– Diagnosis coding classification system used
in the delivery of patient care
• ICD-10
– Used to track mortality data
• ICD-10-CM
– Currently under development
Components of EM codes
Components of EM codes
• All EM services follow a similar format
– Unique code number
– Place and/or type of service
– Content of service
– Nature of the presenting problem
– Time typically associated with service
Components of EM codes
• Ex. 99213, Office or other outpatient visit, est. patient
Unique code number 99213
Place and/or type of
service
Office or other outpatient visit¹
Content of service
•Expanded problem focused history
•Expanded problem focused examination
•Medical decision making of low complexity
Nature of the
presenting problem
Usually, the presenting problem(s) are of low to moderate severity
Time typically
associated with the
procedure
Physicians typically spend 15 minutes face-to-face with the patient
and/or family
¹ Includes hospital outpatient
Categories of EM codes
Categories of EM codes
• Physicians use EM codes to report
professional services
• Documentation in the medical record must
support the EM code and ICD-9 code(s)
submitted
• Submitting a code that is not supported by
documentation may be considered fraud
Categories of EM codes
Office or other Outpatient Services,
New Patient
99201-99205
Office or other Outpatient Services,
Established Patient
99211-99215
Hospital Inpatient Services,
Initial Hospital Care
99221-99223
Hospital Inpatient Services,
Subsequent Hospital Care
99231-99233
Office or Other Outpatient
Consultations,
New or Established Patient
99241-99245
Inpatient Consultations,
New or Established Patient
99241-99255
Categories of EM codes
• Levels of service
– Within each category there are various codes
representing the different levels of service
– Increased levels of service reflect the increased levels
of time, intensity, and complexity of the service
– Ex. Office or other outpatient visit, new patient
•
•
•
•
•
99201 – Level 1
99202 – Level 2
99203 – Level 3
99204 – Level 4
99205 – Level 5
How to properly select and
report EM codes/services
5 Steps to Selecting Appropriate
EM codes/services
• Step 1.- Type of Service: What type of service is the patient
receiving? (office visit, consultation etc.)
• Step 2.- New or Established: If this is an office visit, is this a new or
established patient?
• Step 3.- Key Components: What level of the key components
(history, examination, medical decision making) have been met or
exceeded
• Step 4.- Time: Will time determine the level of E/M service?
• Step 5.- Documentation: Document! Document! Document!
Step 1: Type of Service
• What type of service is the patient
receiving (office visit, consultation etc.)?
– Common EM services performed by
headache specialists
• Office/Outpatient Services
– 99214
» 2005 Medicare utilization by neurologists: 1,768,059
• Consultation Services
– 99244
» 2005 Medicare utilization by neurologists: 519,888
Step 1: Type of Service
• When is a consultation a consultation?
– Consultation
• A type of service provided by a physician whose
opinion or advice regarding evaluation and/or
management of a specific problem is requested by
another physician or other appropriate source
– Not a Consultation
• Ongoing management of the patient by the
consultant physician
Step 1: Type of Service
• When is a consultation a consultation?
– CMS Transmittal 788 – effective 1/17/06
– To bill for a consultation, there must be
documentation of the request
– If there is no request, an outpatient/office visit (new or
established) should be reported
• “…a consultation request may be verbal however the
verbal interaction identifying the request and reason for
a consult shall be documented in the patient’s medical
record by the requesting physician or qualified NPP, and
also by the consultant physician or qualified NPP in the
patient’s medical record.” (CMS Transmittal 788)
Step 1: Type of Service
• When is a consultation an office visit?
– Transfer of care
• A transfer of care occurs when a physician
requests another doctor to assume the care of the
patient for a specific condition
• Once a transfer occurs consultations can no longer
be reported
• Established patient EM codes must be reported
Step 2: New or Established
Patient?
• CPT differentiates between new and
established patients (office/outpatient)
• New patients
– More physician work
– Greater documentation requirements
– Higher reimbursement
Step 2: New or Established Patient?
• Is this a new or established patient?
– New patient: one who has not been seen by
the physician or another physician of the
same specialty who belongs to the same
group within the past 3 years
– Established patient: one who has been seen
by the physician or another physician of the
same specialty who belongs to the same
group within the past 3 years
Step 3: Key Components
• There are six components that are used to
define the level of an E/M service
– History
– Examination
– Medical Decision Making
– Counseling
– Coordination of Care
– Nature of Presenting Problem
– Time
Step 3: Key Components
• The three key components must be
considered and supported by
documentation in the medical record
before selecting a code
– History
– Examination
– Medical decision making
Step 3: Key Components
History
• Elements
–
–
–
–
Chief complaint
History of the present illness (HPI)
Review of symptoms
Past medical, family, and social history (PFSH)
• Levels
–
–
–
–
Problem focused
Expanded problem focused
Detailed
Comprehensive
Step 3: Key Components
History
• Chief complaint
– “A chief complaint is a concise statement
describing the symptom, problem, condition,
diagnosis, or other factor that is the reason for
the encounter, usually stated.”
American Medical Association. Current Procedural Terminology CPT 2007.
Chicago, Ill: AMA press;2007
Step 3: Key Components
History
• History of Present Illness (HPI)
– Must be performed by physician
HPI
Elements
•Location
•Quality
•Severity
•Duration
•Timing
•Context
•Modifying factors
•Associated signs
or symptoms
Levels
Problem
Focused
Expanded
Problem
Focused
Detailed
Comprehensive
Brief
(1-3
elements)
Brief
(1-3 elements)
Extended
(4 or more
elements)
Extended
(4 or more elements)
Step 3: Key Components
History
• Review of Systems (ROS)
– Can be performed by medical extender
Levels
ROS
•Constitutional
(wt loss etc)
•Eyes
•ENT, Mouth
•Respiratory
•Cardiovascular
•GI
•GU
•MS
•Neuro
•Integumentary
•Endocrine
•Hem/lymph
•Allergy/Immun
•Psychiatric
•All others
negative
Problem
Focused
Expanded
Problem
Focused
Detailed
Comprehensive
None
Problem
specific
(1 system)
Extended
(2-9
systems)
Complete
(Greater
than 10
systems or
some with all
others
negative)
Step 3: Key Components
History
• Past Medical, Family, and Social History (PFSH)
– Can be performed by medical extender
Levels
PFSH
Pertinent
At least 1
item from
at least 1
history.
Complete
Specifics of
at least 2
history areas
documented.
All 3 for new
patient.
Problem
Focused
Expanded
Problem
Focused
Detailed
Comprehensive
None
None
Pertinent
Complete
•
Step 3: Key Components
History
Summary
Elements
HPI
History of
Present Illness
ROS
Problem
Focused
Expanded
Problem
Focused
Detailed
Comprehensive
Brief
(1-3
elements)
Brief
(1-3 elements)
Extended
(4 or more
elements)
Extended
(4 or more elements)
None
Problem Specific
Extended
Complete
None
None
Pertinent
Complete
Review of
Systems
PFSH
Past Medical,
Family and
Social History
Step 3: Key Components
Physical Examination
• The level of exam is determined by the
number of body areas or organ systems
documented
• Levels
– Problem focused
– Expanded Problem Focused
– Detailed
– Comprehensive
Step 3: Key Components
Physical Examination
 CPT Descriptors For Four Levels of Physical Examination

Problem focused - A limited examination of the affected body area or organ system(s)

Expanded problem focused - A limited examination of the affected body area or organ
system and other symptomatic or related organ system(s)

Detailed - An extended examination of the affected body area or organ system and other
symptomatic or related organ system(s)

Comprehensive
A general multi-system examination or a complete examination of a single organ system
American Medical Association. Current Procedural Terminology CPT 2007.
Chicago, Ill: AMA press;2007
Step 3: Key Components
Physical Examination
• Documentation guidelines for physical
examination
– 1995 Guidelines (general exams)
– 1997 Guidelines (specialty exams)
– Single system (specialty) examination
» Neurological – recommended for headache
specialists
– General multisystem examination
•
Step 3: Key Components
Physical Examination
1997 Guidelines – Neurological
Constitutional
Eyes
Cardiovascular
Neurological














Measurement of any 3 of 7 vital signs
General appearance of the patient
Ophthalmoscopic examination
Examination of carotid arteries
Auscultation of heart
Examination of peripheral vascular system
Higher cortical functions
Cranial nerves
Sensation
Muscle strength
Muscle tone
Deep tendon reflexes
Coordination
Gait and station
Step 3: Key Components
Physical Examination
• Summary
Level of Exam
1997 Single Organ System
Problem focused
1-5 elements
Expanded Problem Focused
At least 6 elements
Detailed
At least 12 elements
Comprehensive
Perform all elements
Document all elements in
•Constitutional
•Eyes
•Musculoskeletal
•Neurological
Document 1 element in
•Cardiovascular
Step 3: Key Components
Medical Decision Making (MDM)
• What is medical decision making (MDM)?
– MDM refers to the complexity of establishing
a diagnosis and/or selecting a management
option
• Of the three key components of EM, MDM is the
most challenging to meet and document
Step 3: Key Components
Medical Decision Making (MDM)
• How is MDM measured?
– Number of diagnoses or management options
• Number of possible diagnoses
• Number of options that must be considered
– Amount and/or complexity of data to be reviewed
• Amount and/or complexity of medical records, diagnostic tests
and/or other information that must be obtained, reviewed and
analyzed
– Risk of complications and/or morbidity or mortality
• The risk of significant complications, morbidity and/or mortality
associated with the patient’s presenting problem
• The risk of comorbidities associated with the patient’s presenting
problem
• The risk of the diagnostic procedure(s) and/or the possible
management options
Step 3: Key Components
Medical Decision Making (MDM)
• What are the different levels of MDM?
– Straightforward
– Low complexity
– Moderate complexity
– High complexity
Step 3: Key Components
Medical Decision Making (MDM)
• Summary
Number of
diagnoses or
management
options
Amount and/or
complexity of
data to be
reviewed
Risk of
complications
and/or morbidity
or mortality
Type of decision
making
(Level of MDM)
Minimal
Minimal or
None
Minimal
Straightforward
Limited
Limited
Low
Low Complexity
Multiple
Moderate
Moderate
Moderate
Complexity
Extensive
Extensive
High
High
Complexity
Step 3: Key Components
• Choosing an appropriate level of EM
service based on key components
– New patient, office/outpatient and office
consultations
• You must meet or exceed ALL of the requirements
to qualify for a particular level of an EM service
– Established patient, office/outpatient
• You must meet or exceed 2 out of the 3
requirements to qualify for a particular level of an
EM service
Step 3: Key Components
Summary
• New Patient – Office/OP (3 out of 3)
Code
History
Exam
Medical Decision
Making
99201
Problem focused
Problem focused
Straightforward
99202
Extended problem
focused
Extended problem
focused
Straightforward
99203
Detailed
Detailed
Low complexity
99204
Comprehensive
Comprehensive
Moderate Complexity
99205
Comprehensive
Comprehensive
High Complexity
Step 3: Key Components
Summary
• Office or other Outpatient Consultation (3 out of 3)
Code
History
Exam
Medical Decision
Making
99241
Problem focused
Problem focused
Straightforward
99242
Extended problem
focused
Extended problem
focused
Straightforward
99243
Detailed
Detailed
Low complexity
99244
Comprehensive
Comprehensive
Moderate Complexity
99245
Comprehensive
Comprehensive
High Complexity
Step 3: Key Components
Summary
• Established Patient – Office/OP (2 out of 3)
Code
History
Exam
Medical Decision
Making
99211
Minimum services; Physician not required
99212
Problem focused
Problem focused
Straightforward
99213
Extended Problem
Focused
Extended Problem
Focused
Low complexity
99214
Detailed
Detailed
Moderate Complexity
99215
Comprehensive
Comprehensive
High Complexity
Step 4: Time
• Time is included in the definition of levels
of EM services
– Ex. “99213 Office or other outpatient
visit…physicians typically spend 15 minutes
face-to-face with the patient and/or family.”
• This time is considered average time that
may be higher or lower depending on
specific circumstances
Step 4: Time
In certain circumstances the three key
components (history, physical
examination and MDM) are not
the controlling factor
in determining the level of an EM service
Step 4: Time
In certain circumstances
TIME
is the controlling factor
in determining the level of an EM service
Step 4: Time
• Time determines the level of E/M service
when counseling and/or coordination of care
dominate (> 50%) the encounter
– Counseling and coordination is separate from the
history, physical exam and medical decision making
– More common scenario for headache specialists
– The extent of counseling and/or coordination of care
must be documented in the medical record
independent of the three key components
Step 4: Time
• Counseling patient and/or family
– Diagnostic results, impressions, and/or recommended diagnostic
studies
– Prognosis
– Risks and benefits of management (treatment options)
– Instructions for management (treatment) and/or follow-up
– Importance of compliance with chosen management (treatment)
options
– Risk factor education
– Patient and family education
American Medical Association. Current Procedural Terminology CPT 2007.
Chicago, Ill: AMA press;2007
Step 5: Documentation
• General Principles of Medical Record Documentation¹
– Medical record complete and legible
– The documentation of each patient encounter includes:
• Reasons for the encounter and relevant history, physical
examination findings and prior diagnostic test results;
• Assessment, clinical impression or diagnosis;
• Plan for care; and
• Date and legible identity of the provider
– If not documented, the rationale for ordering diagnostic and other
ancillary services easily inferred
¹ 1997 EM Guidelines, Centers for Medicare and Medicaid
Services (CMS)
Step 5: Documentation
• General Principles of Medical Record
Documentation¹
– Past and present diagnoses accessible
– Appropriate health risk factors identified
– Patients progress and response to changes in
treatment included
– CPT and ICD-9 codes supported by documentation
¹ 1997 EM Guidelines, 1997 EM Guidelines, Centers for Medicare
and Medicaid Services (CMS)
Use of modifiers
Use of Modifiers
• What is a modifier?
– Modifiers indicate that a service was altered in some
way from the stated CPT descriptor without changing
the definition
• Why use modifiers?
– When you need to communicate something unusual
about the service to Medicare
• What is the impact of modifiers?
– Modifiers can maintain, reduce or increase
reimbursement levels for a service
Use of Modifiers
• Common modifiers for EM services
– -21: Prolonged evaluation and management services
• Only can be used with the highest level EM service
– -25: Significant, separately identifiable evaluation and
management service by the same physician on the
same day of the procedure or other service
• Appropriate documentation for the need of the EM service
should be recorded in the patient’s medical record
– -52: Reduced services
• Should not be used if there is a code at a lower level that
describes the service provided
Clinical examples
Case #1 – History (HPI, ROS, PFSH)
32 year old woman with PMH of “TTH”. Onset of H/A age
14. H/A associated with vomiting, photophobia &
dysfunction. 8 year history of chronic daily headaches.
Taking Vicodan daily (4-6/D) for 5 years; was taking
Butalbital before Vicodan. Disability for 2 years. New
onset: “visual blurring” OD; Numbness in RUE; Transient
Confusion
Case #1
Level of Care
99241?; 99242?; 99243?; 99244?; 99245?
99201?; 99202?; 99203?; 99204?; 99205?
Physical Exam
Exam: 23 Bullets
BP 210/105; Pulse 72 Irreg.; RR 15; General Exam: Otherwise WNL
Neurological Exam
Higher Cortical Function; Cranial Nerves; Motor; Coordination; Gait; Reflexes
Sensation; All WNL
Diagnosis
1. Migraine with aura; 2. Chronic Daily H/A; 3.Medication Overuse Headache; 4.
Hypertension; 5. R/O Cardiac Arrthymia; 6. R/O CNS Mass Lesion; 7. R/O
Cerebral Vascular Disease (TIA, Cerebral Emboli, Infarct)
Complexity of
Data Reviewed
Reviewed
22 pages of prior records; Head Ct without contrast (2004); CT cervical spine
(2004)
Ordered
MRI Head with contrast; Lab; EKG; Cardiology Consult; Hospital Care?
Risk
Risk of Presenting Problem:
Minimal?; Self Limited or Minor?; Low severity?; Moderate severity?
High severity?
Risk of Management Options?; Risk of Diagnostic Procedures?
Case #1
Pre-service
– Reviewed the medical history form completed by the patient and vital signs
obtained by clinical staff
Intra-service
– A comprehensive History
– A comprehensive neurological exam > 23 Bullets
Medical Decision Making
– Number of Diagnoses or Treatment Options >4
– Amount / Complexity of Data Reviewed > 4
– Using Table of Risk:
• “One or more chronic illnesses with severe exacerbation, progression, or
side effects of treatment”
• “An abrupt change in neurologic status, e.g. seizure, TIA, weakness,
sensory loss”
• “Drug therapy requiring intensive monitoring for toxicity”
Case #1
Post-service
– Complete the medical record documentation
– Provide necessary post evaluation care and
coordination of care
The Level of Care would be 99205 because History
and Exam were Comprehensive and MDM was High
Complexity. This would not be a Consultation or
99245 because the referral requires a transfer of
care for further E /M.
Case #2 – History (HPI, ROS, PFSH)
29 year old woman with PMH of MH without aura.
Established Pt. Hospitalized 2 years ago due to
medication overuse headache; took Fiorocet daily for 3
years; now on Topamax; limits abortive triptan to 2 days
per week. Is Bipolar; Has insomnia; Had “Syncopal
Spell” one day ago with loss of bladder control; struck
head . New onset vertigo.
Case #2
Level of Care
Office Visit: 99212?; 99213?; 99214?; 99215?
Physical Exam
Exam: 23 Bullets
BP 130/80; Pulse 72 regular RR 16; Bruise on R frontal area from trauma when
fell; General Exam: Otherwise WNL
Neurological Exam
Awake, alert, coherent. Memory/intellect intact No aphasia or dysarthria CN’s:
WNL; Motor exam wnl Coordination intact; Gait; no ataxia; Reflexes: wnl;
Sensation: intact
Diagnosis
1.Migraine with aura; 2. Medication overuse headache by history; 3. Bipolar
disorder; 4. Sleep disorder; 5.Syncope; 6. Head trauma due to #5; 6. R/O
vasovagal syncopy; 7. R/O seizure; 8. New onset Vertigo
Complexity of
Data Reviewed
Reviewed
1.Current chart; 2. Hospital records; 3. All current meds
Ordered
1.Lab; 2.Repeat MRI of head; 3.EEG; 4.EKG
Risk
Risk of Presenting Problem:
Minimal?; Self Limited or Minor?; Low severity?; Moderate severity?
High severity?
Risk of Management Options?; Risk of Diagnostic Procedures?
Case #2
Pre-service
– Reviewed the medical history form completed from the patient, vital signs obtained by the
clinical staff
Intra-service
– Obtained a comprehensive history including a review of all medications for possible drug
interactions. Compared status to last visit. Performed comprehensive neuro exam.
Considered relevant data, options, and risks; formulated a diagnosis; developed a treatment
plan. Discussed diagnosis, treatment options and risks with patient and family. Ordered and
arranged diagnostic testing.
Medical Decision Making
– Number of Diagnoses or Treatment Options list 5 established Dx. & 2 R/O Dx .
– Amount / Complexity of Data Reviewed >4
– Using the Table of Risk:
• “One or more chronic illness with severe exacerbation, progression, or side effects of
treatment”
• “An abrupt change in neurologic status, e.g.. seizure, TIA, weakness, sensory loss”
“Drug therapy requiring intensive monitoring for toxicity”
Case #2
Post-service
–
Complete medical record documentation. Provide
necessary communication and coordination of care.
Respond to testing results and revise treatment plan.
The level of care would meet the criteria for
99215 because not only 2 out of 3 but 3 out of 3
requirements were met; a comprehensive
History, Exam and High Complexity MDM
Case #3 – History (HPI, ROS, PFSH)
33 year old woman; 10 year history of MH without aura.
Established pt. Hospitalized at another clinic 5 years ago
because of MOH. Did well until 4 mo ago; recurrent daily
“migraine” with 7 days a week of OTC use & triptans
bid 4 days a week. On Inderal for headache and BP
control. New onset stress; crying; not sleeping. C/O
difficulty “Coping”.
Case #3
Level of Care
Office Visit: 99212?; 99213?; 99214?; 99215?
Physical Exam
Exam: 12 Bullets
BP 160/90; Pulse; 90 Regular; RR 17; Pt appeared depressed; crying
Neurological Exam
MS. Awake, alert, coherent; affect flat; judgment impaired; intellect and memory
intact; no dysarthria/aphasia; CN disc flat OU, 3,6,7,12 intact: Motor: Coordination:
Gait: intact
Diagnosis
1.Migraine without aura; 2. New Onset Chronic Daily Headache; 3.Medication
Overuse Headache (OTC, Triptans); 4. Hypertension; 5. New Onset Depression; 6.
R/O acute CNS lesion
Complexity of
Data Reviewed
1.Records including prior medication history reviewed; 2. Patient has had no recent
lab; studies ordered to include CBC, SMA, Sed rate, Thyroid profile; 3. Repeat
MRI? ; 4. Will Discuss meds, clinical change, with PCP
(Time spent with patient: 35 minutes)
Risk
Greater than 50% of the time was spent in coordination of care
1.Discussed prognosis if not treated; 2. Discussed Risk of Medication Overuse; 3.
Discussed Risk and benefits of treatment options; 4. Discussed Risk of noncompliance; 5. Discussed tests ordered and future tests if need; 6. Discussed
instructions for treatment and follow-up.
Case #3
Pre-service
– Reviewed the medical history form completed by the patient and vital signs
obtained by the clinical staff. Discussed new symptoms with the NP.
Intra-service
– An extended problem focused history including current meds for headache
control and antihypertensive meds. Discussed new onset daily headaches and
depression. Discussed risk of using triptans with hypertension and use of Inderal
in depression
– Performed an extended problem focused examination including mental status
Medical Decision Making
– Number of Diagnoses or Treatment Options > 4
– Amount / Complexity of Data Reviewed > 2
– Using the Table of Risk:
• “One or more chronic illnesses with severe exacerbation, progression, or
side effects of treatment”
• “Prescription drug management”
Case #3
Post-service
– Complete medical record documentation
– Provide coordination of care and review with PCP; consider Psych
consult
The H & P are Extended Problem Focused. The CPT level of care
would be 99213. However, since greater than 50% of time was
spent in Counseling and Coordination of Care, if that criteria were
used, the level of care would be coded as 99214.
The counseling and discussion included prognoses, risks and
benefits of treatment options, instructions for treatment and follow
up, importance of compliance, risk factors of current course, and risk
factor reduction with proper management.
Coding resources
Coding resources
• American Headache Society (AHS)
– AHS’s Headache Coding Corner
• http://www.americanheadachesociety.org/professionalresources/AHSs
HeadacheCodingCorner.asp
• American Medical Association
– CPT-related resources
• http://www.ama-assn.org/ama/pub/category/3113.html
• Centers for Medicare and Medicaid Service (CMS)
– Evaluation and Management Services Guide
• http://www.cms.hhs.gov/MLNProducts/downloads/eval_mgmt_serv_guide.pd
f
– 1997 Documentation Guidelines for Evaluation and Management
Services
• http://www.cms.hhs.gov/MLNEdWebGuide/25_EMDOC.asp
Next AHS Coding Webcast
Don’t forget to register for our next
Webcast: Understanding Medical Decision
Making (MDM) on October 16.
To register please go directly to:
https://americanheadachesociety.webex.c
om/americanheadachesociety/onstage/g.p
hp?p=0&t=m
Thank You
The American Headache Society thanks
you for your participation.
We will now take questions.
Please contact American Headache Society (AHS) headquarters for
further information: [email protected] or 856-423-0043.