Medical Billing and Coding Training - Understand E/M coding guidelines for 1995 and 1997 to ensure a compliant orthopedic practice

Insurance carriers closely scrutinize services related to Evaluation and Management as documenting these services requires one to follow innumerable guidelines. The two basic guidelines of 1995 and 1997 have a huge impact on the way claims are being reported that effects reimbursement too.

It is important to have extensive medical billing and coding training to understand the documentation requirements to file error-free claims.

Example: In orthopedic practice, if one has to bill for a comprehensive exam, according to the 95 guideline what body area or organ does one need to address. Can body areas and organ systems be mixed when elements for the exam will be counted.

Solution: The physician has to decide the organ system and body should be examined. Every medical record is scrutinized for reasonable and medically necessary services, so it is the duty of the provider to execute the work and based on it decide what level of service needs to be billed. The physician’s clinical judgment determines the extent of the exam performed and documented the nature of the problem and the medical necessity of the case.

In the 1995 E/M guidelines, the multi organ system physical examination has been stated and in the 1997 guidelines, the general multi system and single organ system examinations have been stated. Also in the 1997 guidelines, musculoskeletal examination has been mentioned and the physician may determine the bullet points in the examination charts.

The 1997 Exam rules are well-defined and makes following the rules quite easy giving confidence before any audit. According to an auditor, this is a good way to define Exam Level by the bullets. An essential thing is that physicians should use exam templates which contain the most clinically relevant bullets, whereas the 1995 Exam guidelines lack such solid guidelines.

If you are looking for online medical coding training conferences, Audio Educator is the place where you can choose a wide range of webinars for medical billing and coding training and dental coding training to stay compliant.