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J a n u a r y 2 0 1 2 M a r c h 2 0 1 2 A u g u s t 2 0 1 2

Which EHR works best for endocrinology offices? This question is often asked by our members and we would like the opportunity to provide this information to our members. This survey addresses the high and low points encountered either as a current or prospective EHR user with regards to selection and purchase, implementation and training, as well as the pros and cons of your everyday experiences. Take the survey.

What is the impact of Medicare payment cuts for DXA on your practice? Participation in this brief 16-question survey will provide important new data that can be used this fall in AACE advocacy efforts on Capitol Hill. New data will help AACE make the case to Congress that current Medicare payment policy is harming access to osteoporosis testing and treatment services. Take the survey

October 3rd is the last day for eligible professionals (EPs) to begin their 90-day reporting period for CY 2012 for the Medicare EHR Incentive Program. CMS’ User Guides: An Introduction to the Medicare / Medicaid EHR

Incentive Program for Eligible Providers Meaningful Use Stage 2 (which will begin as early as 2014) increases health information exchange between providers and promotes patient engagement by giving patients secure online access to their health information. More information

New Projected Effective Date of October 1, 2014 For more information click here

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Help ensure your success in the EHR incentive programs by registering early! Registering does not mean you are required to participate -- so register today. CMS recommends that all eligible professionals (EPs) register as early as possible for Medicare and Medicaid’s EHR incentive programs. If you register early, you can verify that your information is current in all of CMS’ systems and resolve any issues, so you may participate in the EHR incentive programs. If you do not resolve registration problems in time, you will not be able to attest and could potentially miss a payment year. This is the last year for Medicare eligible professionals (EPs) to start participating in the EHR incentive programs in order to receive their full Medicare incentive payments. For more information on registration in the EHR incentive programs, visit the Registration section

of the EHR incentive programs Web page for the latest news and updates on the EHR incentive programs.

Any provider attesting to receive an EHR incentive payment for

either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program potentially may be subject to an audit.

More information

Provider Compliance

Group Interactive Map The U.S. Resource Map allows you to access state-specific organizations that provide services in your state, contact information of various organizations, and e-mails and websites to the different organizations within the state selected.

Members in Ohio Look for Overpayment Letters

in Blue Envelopes! Beginning August 13, 2012, CGS will send all overpayment letters (demand letters) in light blue envelopes. Requests for repayment of Medicare funds are time-sensitive, and we hope that this change in envelope color will help you quickly and easily identify these requests. Read more...

2012 Physician Quality Reporting System Program Reminder: It is not too late to start participating in the 2012 Physician Quality Reporting System (PQRS) and potentially qualifies to receive an incentive payment equal to 0.5% of an eligible professional’s total Medicare Part B allowed charges for services furnished during the reporting period. A new six month reporting period using the registry submission option began on July 1, 2012. In addition, there are still ways to participate in the 12-month reporting period using claims, registry or EHR submission. Read more...

According to Medscape Today, The US Centers for Medicare and Medicaid Services (CMS) is auditing — and rattling — an unspecified number of physicians and hospitals that have been awarded hefty incentive payments for meaningful use of EHR technology. The audited providers are receiving letters from a CMS contractor asking that they submit extra documentation within 2 weeks to support their claims that they met federal meaningful-use criteria. CMS will recoup bonuses from those who turn out not to have deserved the payments. Click here for the complete article.

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Did you know effective August 1, 2012 the 4010A1 format of the electronic remittance advice, the Medicare Fee-For-Service (FFS) program automatically converted your electronic remittance advice to the X12 Version 5010 format? If the computer software you use to open/translate the electronic remittance advice X12 Version 5010 format is not ready for this conversion, you may not be able to open and read the electronic remittance advice to review payments, adjustments, and denials, as well as post payments to patient accounts. If you use a vendor, clearinghouse, or billing service for receipt of your electronic remittance advice and your computer software is unable to open/translate the electronic remittance advice X12 Version 5010 format, please contact your vendor, clearinghouse, or billing service before contacting your Medicare contractor. Providers should be advised that any billing staff or representatives that make inquiries related to Medicare payment on his/her behalf will need a copy of the remittance advice.

Reports concerning the correct limiting charge including the eRx Negative Adjustment Limiting charge amount for Medicare Physician Fee Schedule (MPFS) services are found in this article . Submission of a non-participating, non-assigned MPFS service with a charge in excess of the Medicare limiting charge amount constitutes a violation of the limiting charge. A provider who violates the limiting charge is subject to assessments of up to $10,000 per violation plus triple the amount of the charges in violation, and possible exclusion from the Medicare program. Therefore it is crucial that Eligible Professionals (EPs) are provided with the correct limiting charge they may bill for a MPFS service. Make sure that your billing staff are aware of these changes.

WPS Medicare, a Medicare Administrative Contractor will send educational letters and Comparative Billing Reports (CBR) to various providers focusing on analysis of E/M CPT code categories 99201-99205 and 99221-99223. The reports were developed for providers who met the following criteria:

• At least 100 allowed services in a twelve month period for any code within either E/M category

• Billing one CPT code within either E/M category at least 85% of the time

The individual provider is sent a CBR comparing their billing data to other J5 providers within their specialty for the specific E/M CPT code category. In addition, each provider will receive a Comprehensive Error Rate Testing (CERT) Program and E/M Services website resources guide. For more information to assist your practice with proper billing and documentation of E/M services, refer to the article on our CERT page here

New Physician Specialty Code for Centralized Flu CMS established a new non-physician practitioner specialty code for Centralized Flu effective January 1, 2013. The new non-physician practitioner specialty code for Centralized Flu is C1 and is only applicable to the CMS-855B enrollment application. Make sure that your billing staffs are aware of this change for 2013.

4

CMS Guidance to

Address Billing Errors

cost-sharing reductions, or other health care programs like the Children’s Health Insurance Program. Small employers will be eligible to receive tax credits for coverage purchased for employees through the Exchange. These competitive marketplaces make purchasing health insurance easier and more understandable and offer consumers and small businesses increased competition and choice. More information

CMS FRAUD PREVENTION TRAINING MODULES FOR PROVIDERS were released June 2012, have a total of 1.25 hours of continuing medical education (CME) credit that can be earned for any Medscape user registered as a doctor or health care professional. Medscape accounts are free, and users do not have to be health care professionals to register for them.

Module 1, "Reducing Medicare and Medicaid Fraud and Abuse: Protecting Practices and Patients"

Module 2 "How CMS Is Fighting Fraud: Major Program Integrity Initiatives"

The articles listed below are provided by Practice Management Institute. They offer a variety of practice management articles to

assist you in running a compliant and efficient office.

What You Don’t Know About OSHA Can Hurt You D.K. Everitt, Chief Compliance Officer, The Compliance Division, LLC

Keeping Negativity In the Workplace At Bay

Managing When the Stress Doesn’t Go Away

AACE assumes no liability for the purchase(s) of these programs. The content of the program(s) does not necessarily represent the policies or opinions of AACE. All purchases and communications are between the attendee and the company.

October 2012 QUARTERLY

AVERAGE SALES PRICE MEDICARE

PART B DRUG PRICING FILES

Medicare will use the October 2012 quarterly ASP Medicare Part B drug pricing files to determine the payment limit for claims for separately payable Medicare Part B drugs processed or reprocessed on or after October 1, 2012, with dates of service from October 1, 2012, through December 31, 2012. MLN Matters® article MM7885

A complete list of the National Medicare

Training Power Point modules are found here.

Modules are self-paced, individual learning tools for partners, information givers, and trainers who share in-depth information about the Medicare Program to people with Medicare, and are not legal documents. The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings, and can be found on this web site.

STATES CONTINUE TO MOVE FORWARD, BUILDING AFFORDABLE INSURANCE EXCHANGES In every state, Exchanges will allow consumers to shop for and enroll in private health plans that meet their needs. Consumers will be able to learn if they are eligible for tax credits and

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Become an AACE- Certified Endocrine Coder

Philadelphia, PA

Fundamentals and Advanced Endocrine Coding will be offered in Philadelphia on November 9-10, 2012. All attendees are offered the AACE-Certified Endocrine Coder exam for no additional charge on November 10. November 9 8:00 am – *5:00 pm Fundamentals in Endocrine Coding will focus on foundational coding concepts. The course is designed for physicians, non-physicians, medical coders, billers, and practice managers. Topics of discussion include:

• Medical records, documentation, and appropriate use of signatures • Conventions, guidelines, and appropriate selection of ICD-9-CM codes • Conventions, guidelines, and appropriate selection of CPT® and HCPCs codes • Common endocrinology modifiers and the principles behind them • Common endocrinology procedures such as injections, infusions, FNAs, and ultrasounds

November 10 8:00 am- *4:00 pm Advanced Endocrine Coding will focus on Evaluation and Management coding concepts, conventions, and calculations of the various levels commonly used by endocrinologists. This course is designed for physicians, non-physicians, medical coders, billers, and practice mangers. *Times will vary based on class participation.

November 9th **8 am – 5:00 pm (includes continental breakfast)

November 10th **8 am – 4:00 pm (includes continental breakfast & light lunch)

*AACE CEC Exam **4 pm – 6 pm **Times vary based on class questions and participation. Embassy Suites Philadelphia Airport 9000 Bartram Avenue Philadelphia, PA 19153 215-365-4500 Room Block under “AAC” (NO E is required) What is an AACE- Certified Endocrine Coder (AACE-CEC)

Contact Vanessa Lankford at vlankford@aace.com or 904-353-7878 for additional information. AACE reserves the right to cancel any course with a minimum 48-hour notification. Participants will have the option to attend in an alternate course (if available) or request a full refund.

REGISTER

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Distance Learning and Total Access with PMI®

Month by month - cancel at any time

$225 per month AACE members & staff *Registrants must use promotional code “AACE” to receive discount. $249 Non AACE members

• Live weekly webinars where you can ask specific questions and get direct answers on a variety of current topics important to your practice

• 24-hour access to TOTAL ACCESS Audio Library with almost 200 hours of pre-recorded training sessions and choose from 100+ topics

• A fast way to bring both experienced and new staff up-to-speed on current issues • Include your physician to learn about important coding, billing, compliance and operational updates • Inexpensive, convenient way to develop your own talent without leaving the office to attend training classes • Use your office's speakerphone so that multiple staff can participate

Topics include: ICD-10 Diagnosis Coding for Endocrinology (pre-recorded) Teambuidling for Practice Success (scheduled for 9/6/2012) HB 300- HIPAA Privacy is No longer Just a Federal Concern (scheduled for 9/13/2012) Mastering Medical Decision Making (previously recorded) Translating Efficiencies to Profit (previously recorded) Conducting “Payer Proof” E/M Chart Audits (previously recorded) Top 5 Concerns of Medical Practice Managers (Listen to a sample of the prerecorded material in the middle

of the page here) Compliance is NOT an Option (previously recorded)

PMI National Certifications via Webinar

Live Certification Webinars include 10 to 12 90-minute learning sessions taught in a live Webinar format via your computer. Interact, ask questions and get answers real-time. This option includes the full course manual shipped to the candidate's address plus access to the streamed versions of the live sessions to review anytime. Once the candidate is ready to take the exam, he/she will arrange with PMI for an exam proctor to administer the test live in a nearby community. Learn more.

Certified Medical Insurance Specialist Certified Medical Coder Certified Medical Compliance Officer Certified Medical Office Manager Payment plans available! *Use promotional code AACE when registering. For more information or to register call 800-259-5562 x242. AACE assumes no liability for the purchase(s) of these programs. The content of the program(s) does not necessarily represent the policies or opinions of AACE. All purchases and communications are between the attendee and the company.

www.pmimd.com

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All medical coding must be supported with documentation and medical necessity. **While this document represents our best efforts to provide accurate information and useful advice, we cannot guarantee that third-party payers will recognize and accept the coding and documentation recommendations. As CPT®, ICD-9-CM and HCPCS codes change annually, you should reference the current CPT®, ICD-9-CM and HCPCS manuals and follow the "Documentation Guidelines for Evaluation and Management Services" for the most detailed and up-to-date information. This information is taken from publicly available sources. The American Association of Clinical Endocrinologists cannot guarantee reimbursement for services as an outcome of the information and/or data used and disclaims any responsibility for denial of reimbursement. This information is intended for informational purposes only and should not be deemed as legal advice, which should be obtained from competent local counsel. Current Procedural Terminology (CPT©) is copyright and trademark of the 2011 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT©. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

We want to hear

from you! Tell us what you think of Endonomics! Please take a few minutes to take this survey. Your feedback is very important to us as we strive to assist you with a profitable and compliant business office.

o Is Endonomics™ valuable and useful for your office?

o What other topics would you like to see offered in Endonomics™?

o Other comments… AACE's Socioeconomics and Member Advocacy Department's goal is to reach out to the endocrinology business world and become the one- stop- shop, not only for endocrinology clinicians, but their support staff as well. Currently, Endonomics™ is currently a free newsletter for both members and non-members. Interested parties should send an e-mail to Endonomics@aace.com with their name, phone and fax numbers, location and preferred e-mail address to be added to our Practice Support Network database.

Coding TRAC

Tips on Reimbursement And Coding CMS information, guides, booklets, and other helpful links relating to endocrinologists. FREE ICD-9-CM and HCPCS code look ups!

How do I get a diagnosis code to be added?

ICD-9-CM coding conventions Chapter 3: Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders (240-279) indicates the following:

• When assigning codes for diabetes and its associated conditions, the code(s) from category 250 must be sequenced before the codes for the associated conditions. The diabetes codes and the secondary codes that correspond to them are paired codes that follow the etiology/manifestation convention of the classification (See Section I.A.6., Etiology/manifestation convention).

• Assign as many codes from category 250 as needed to identify all of the associated conditions that the patient has. The corresponding secondary codes are listed under each of the diabetes codes.

• When assigning codes for secondary diabetes and its associated conditions (e.g. renal manifestations), the code(s) from category 249 must be sequenced before the codes for the associated conditions.

• The secondary diabetes codes and the diabetic manifestation codes that correspond to them are paired codes that follow the etiology/manifestation convention of the classification.

• Assign as many codes from category 249 as needed to identify all of the associated conditions that the patient has. The corresponding codes for the associated conditions are listed under each of the secondary diabetes codes. For example, secondary diabetes with diabetic nephrosis is assigned to code 249.40, followed by 581.81.

For a complete list of Chapter 3: Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders see an ICD-9-CM book’s Section 1. Conventions, general coding guidelines and chapter specific guidelines or find them online here.

Please submit comments or questions to Endonomics@aace.com.

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E/M Calculation,

Coding & Documentation

Series

According to CMS’ Web site, “Carriers and A/B Medicare Administration Contractors are to continue reviews using both the 1995 and 1997 documentation guidelines (whichever is more advantageous to the physician).” B e g i n n i n g i n J a n u a r y 2 0 1 2 , A A C E ’ s S o c i o e c o n o m i c a n d M e m b e r A d v o c a c y D e p a r t m e n t s t a r t e d a s e r i e s o f e x a m p l e s f o r a n i n - d e p t h l o o k a t t h e k e y c o m p o n e n t s a n d a p p r o p r i a t e c a l c u l a t i o n s o f t h e o f f i c e e v a l u a t i o n a n d m a n a g e m e n t l e v e l s b a s e d o n 1 9 9 5 g u i d e l i n e s . A u g u s t w i l l c o n c l u d e t h e s e r i e s w i t h a p p r o p r i a t e c a l c u l a t i o n s a n d e x p l a n a t i o n s o f t h e k e y c o m p o n e n t o f m e d i c a l d e c i s i o n - m a k i n g . I n f u t u r e e d i t i o n s o f E n d o n o m i c s ™ , w e w i l l b u i l d o n t h e o f f i c e n o t e e x a m p l e a n d p r o v i d e f u r t h e r e x p l a n a t i o n s o n c o r r e c t c o d i n g a n d d o c u m e n t a t i o n o f a d i a g n o s t i c u l t r a s o u n d , u l t r a s o u n d g u i d e d b i o p s y a n d o t h e r c o m m o n p r o c e d u r e s p e r f o r m e d b y e n d o c r i n o l o g i s t s . W e w i l l i n c l u d e e x p l a n a t i o n s o f a p p r o p r i a t e m o d i f i e r u s e a g e a s w e l l i n t h e e x a m p l e . I n t h i s s e r i e s o f a r t i c l e s , c o r r e c t c o d i n g g u i d e l i n e s a r e d i s c u s s e d b u t t h a t m a y n o t l e a d t o r e i m b u r s e m e n t . I n s u r a n c e g u i d e l i n e s v a r y b a s e d o n g e o g r a p h i c a l l o c a t i o n , i n d i v i d u a l p r o v i d e r s o f s e r v i c e c o n t r a c t s , p a t i e n t p l a n s a n d s t a t e r u l e s a n d r e g u l a t i o n s . W e e n c o u r a g e y o u t o b e c o m e f a m i l i a r w i t h y o u r i n d i v i d u a l M e d i c a r e A d m i n i s t r a t i v e C o n t r a c t o r , y o u r p r i v a t e c o n t r a c t s w i t h c o m m e r c i a l c a r r i e r s , a n d y o u r l o c a l a n d s t a t e g u i d e l i n e s r e g a r d i n g s e r v i c e s a n d p r o c e d u r e s y o u p r o v i d e t o p a t i e n t s . F u r t h e r q u e s t i o n s o r c o n c e r n s s h o u l d b e a d d r e s s e d t o E n d o n o m i c s @ a a c e . c o m .

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Joan Smith 2/12/71 Established Patient Number: 1234567-A Date of Service: xx/xx/xxxx Cc: throat/neck hurts Ms. Smith is here today complaining of her neck being sore. It has gotten worse since Saturday and seems to most painful in the mornings. A heating pad helps but it is still hard to swallow. There has been a slight decrease in her weight from the last visit, but does not complain of fever. She does not have any ear pain, mouth sores, rhino rhea, vomiting, diarrhea, blurred vision, or neck trauma. Ms. Smith has also noticed diaphoresis and some hair loss and skin sensitivity over the area where her neck is sore. Ms. Smith is a retired registered nurse who was recently diagnosed with diabetes type 2 but has it under control. Her mother had hypothyroidism. She has never smoked and uses alcohol socially. She has no known allergies. Examination revealed normal pharyngeal findings, mucosa normal, and no drainage seen. On her posterior neck, she had skin findings of acanthosis nigricans. The salivary glands and lymph nodes were normal. Her thyroid was enlarged and firm, with a 1-centimeter nodule palpable in the lower portion of the left lobe. There was no tenderness noted anywhere in the neck. I personally performed a diagnostic ultrasound which revealed a 1.2 CM left thyroid nodule. After discussing the findings with Ms. Smith, it was decided to attempt to obtain an ultrasound guided FNA of the left thyroid nodule today. Order labs for a thyroid panel due to the weight decrease, a CBC with diff, and a chemistry panel. Schedule a f/u visit for 2 weeks. J. Endocrinology MD

Sample note only

1 0

Medical Decision Making Complexity of medical decision-making is the component for determining medical necessity for visits, procedures, and other services the patient obtains. Three categories determine the level of medical complexity and two of the three categories must be met or exceeded to calculate medical decision-making.

1. Number of Diagnoses and/or Management Options 2. Amount and/or Complexity of Data 3. Risk of Complications, Morbidity and/or Mortality

Number of Diagnosis and/or Management Options: Self-limited or minor problem (1 point: max is 2 points) Established; stable, improved (1 point) Established; worsening (2 points) New, no additional workup (3 points; max is 1 new problem no additional workup) New problem with additional work up planned. (4 points) High Complexity for the number of diagnosis and/or management options.

MDM Level Straightforward Low

Complexity Moderate

Complexity High Complexity

Number of Diagnosis and/or Management

Options

Minimal ≤ 1 Limited 2 Moderate 3 Extensive/High ≥ 4

Amount and/or Complexity of Data

Minimal ≤ 1 Limited 2 Moderate 3 Extensive/High ≥ 4

Risk of complications, Morbidity and/or

Mortality Minimal Low Moderate High

©2012 AACE. All rights reserved. No portion of this slide presentation may be altered, reproduced or distributed in any form without express written permission from AACE.

I p e r s o n a l l y p e r f o r m e d a d i a g n o s t i c u l t r a s o u n d r e v e a l i n g a 1 . 2 c m l e f t t h y r o i d n o d u l e . A f t e r d i s c u s s i n g t h e f i n d i n g s w i t h M s . S m i t h , w e d e c i d e d t o a t t e m p t t o o b t a i n a n u l t r a s o u n d g u i d e d F N A o f t h e l e f t t h y r o i d n o d u l e t o d a y . O r d e r l a b s f o r a t h y r o i d p a n e l d u e t o t h e w e i g h t d e c r e a s e , a C B C w i t h d i f f , a n d a c h e m p a n e l .

1 1

Amount and/or complexity of data: Review or order clinical lab tests (1 point) Review or order radiology test (1 point) Review or order medicine test (PFTs, EKG, cardiac echo or cath) (1 point) Discuss test with performing physician (1 point) **Independent review of image, tracing, or specimen (2 points) Decision to obtain old records (1 point) Review & summarize old records (2 points) **We would not count an “independent review of the ul trasound image” in the MDM calcula t ion because typ ical ly endocrino logis ts o wn thei r own ultrasound equipment and provide a complete wr i t ten report o f the diagnost ic ul trasound. In this example the physic ian would report CPT ® 76536 (Diagnostic head/neck ul trasound) indica t ing he/she o wned the equipment and provided a separate wri t ten repor t . I t could be considered “double dipp ing” to count the image review in the MDM.

MDM Level Straightforward Low ComplexityModerate

ComplexityHigh Complexity

Number of Diagnosis and/or Management

Options

Minimal ≤ 1

Limited 2 Moderate 3 Extensive/High ≥ 4

Amount and/or Complexity of Data

Minimal ≤ 1

Limited 2 Moderate 3 Extensive/High ≥ 4

Risk of complications, Morbidity and/or

MortalityMinimal Low Moderate High

©2012 AACE. All rights reserved. No portion of this slide presentation may be altered, reproduced or distributed in any form without express written permission from AACE.

I p e r s o n a l l y p e r f o r m e d a d i a g n o s t i c u l t r a s o u n d r e v e a l i n g a 1 . 2 c m l e f t t h y r o i d n o d u l e . A f t e r d i s c u s s i n g t h e f i n d i n g s w i t h M s . S m i t h , w e d e c i d e d t o a t t e m p t t o o b t a i n a n u l t r a s o u n d g u i d e d F N A o f t h e l e f t t h y r o i d n o d u l e t o d a y . O r d e r l a b s f o r a t h y r o i d p a n e l d u e t o t h e w e i g h t d e c r e a s e , a C B C w i t h d i f f , a n d a c h e m p a n e l .

2 points

1 2

Risk of Complications, Morbidity and/or Mortality:

Level of risk

Presenting Problem (s)Diagnostic Procedure(s)

OrderedManagement Options

Selected

Minimal

•One self-l imited or minor problem(e.g., cold, insect bite, tineacorporis)

• Laboratory tests requiringvenipuncture• Chest x-rays• EKG/EEG• Urinalysis• Ultrasound (e.g., echocardiography)• KOH prep

• Rest• Gargles• Elastic bandages• Superficial dressings

Low

• Two or more self-l imited or minor problems• One stable chronic i l lness(e.g., well controlled hypertension, non-insulin dependent diabetes, cataract, BPH)• Acute uncomplicated i l lness or injury (e.g., cystitis, allergic rhinitis, simple sprain)

• Physiologic tests not under stress(e.g., pulmonary function tests)• Non-cardiovascular imaging studies with contrast (e.g., barium enema)• Superficial needle biopsies• Clinical laboratory tests requiring arterial puncture• Skin biopsies

• Over-the-counter drugs• Minor surgery with no identified risk factors• Physical therapy• Occupational therapy• IV fluids without additives

Moderate

• One or more chronic i l lnesses with mild exacerbation, progression, or side effects of treatment• Two or more stable chronic i l lnesses• Undiagnosed new problem with uncertain prognosis (e.g., lump in breast)• Acute i l lness with systemic symptoms (e.g., pyelonephritis, pneumonitis, colitis)• Acute complicated injury(e.g., head injury with brief loss of consciousness)

• Physiologic tests under stress (e.g., cardiac stress test, fetal contraction stress test)• Diagnostic endoscopies with no identified risk factors• Deep needle or incisional biopsy• Cardiovascular imaging studies with contrast and no identified risk factors (e.g., arteriogram, cardiac catheterization)• Obtain fluid from body cavity (e.g., lumbar puncture, thoracentesis, culdocentesis)

• Minor surgery withidentified risk factors• Elective major surgery(open, percutaneous or endoscopic) with no identified risk factors• Prescription drug management •Therapeutic nuclear medicine• IV fluids with additives• Closed treatment of fracture or dislocation without manipulation

High

• One or more chronic i l lnesses with severe exacerbation, progression, or side effects of treatment• Acute or chronic i l lnesses or injuries that pose a threat to l ife or bodily function (e.g., multiple trauma, acute MI, pulmonary embolus, severe respiratory distress, progressive severe rheumatoid arthritis, psychiatrici l lness with potential threat to self or others, peritonitis, acuterenal failure)• An abrupt change in neurologic status (e.g., seizure, TIA, weakness, sensory loss)

• Cardiovascular imaging studies with contrast with identified risk factors •Cardiac electrophysiological tests• Diagnostic Endoscopies withidentified risk factors• Discography

• Elective major surgery (open, percutaneous or endoscopic) with identified risk factors• Emergency major surgery (open, percutaneous or endoscopic)• Parenteral controlled substances• Drug therapy requiring intensive monitoring for toxicity• Decision not to resuscitate or to de-escalate care because of poor prognosis

Per CMS’ Evaluation and Management Services Guide page 85: “The assessment of risk of the presenting problem(s) is based on the risk related to the disease process anticipated between the present encounter and the next one. The assessment of risk of selecting diagnostic procedures and management options is based on the risk during and immediately following any procedures or treatment.

• Undiagnosed new problem with uncertain prognosis

1 3

The highest level of risk in any one category (presenting problem(s), diagnostic procedure(s), or management options) determines the overall risk.”

MDM Level Straightforward Low ComplexityModerate

ComplexityHigh Complexity

Number of Diagnosis and/or Management

Options

Minimal ≤ 1

Limited 2 Moderate 3 Extensive/High ≥ 4

Amount and/or Complexity of Data

Minimal ≤ 1

Limited 2 Moderate 3 Extensive/High ≥ 4

Risk of complications, Morbidity and/or

MortalityMinimal Low Moderate High

Two of the three categories must be met or exceeded to calculate the medical decision-making.

MDM Level Straightforward Low ComplexityModerate

ComplexityHigh Complexity

Number of Diagnosis and/or Management

Options

Minimal ≤ 1

Limited 2 Moderate 3 Extensive/High ≥ 4

Amount and/or Complexity of Data

Minimal ≤ 1

Limited 2 Moderate 3 Extensive/High ≥ 4

Risk of complications, Morbidity and/or

MortalityMinimal Low Moderate High

The number of diagnosis and/or management options EXCEEDED moderate complexity and the risk of complications, morbidity and/or mortality was equal to MODERATE. Two of the three categories in the example was met and/or exceeded to calculate a MODERATE level of MDM. ©2012 AACE. All rights reserved. No portion of this slide presentation may be altered, reproduced or distributed in any form without express written permission from AACE.

1 4

An established patient requires 2 of the 3 key components (history, exam, medical decision making) be met or exceeded. In the chart below, the history component was comprehensive (see February 2012 Endonomics™), the exam was detailed (see April 2012 Endonomics™) and the MDM was moderate. CPT© code 99214 is the appropriate office visit evaluation and management code.

Key Components 99211 99212 99213 99214 99215

History Problem Focused Expanded Problem Focused Detailed Comprehensive

Exam Problem Focused Expanded Problem Focused Detailed Comprehensive

MDM Straightforward Low Complexity Moderate Complexity High Complexity

May not require the presence of

a physician.

In the next edition of Endonomics™, we will discuss appropriate coding for the diagnostic ultrasound and what- if any modifiers are required on the evaluation and management CPT© code. ©2012 AACE. All rights reserved. No portion of this slide presentation may be altered, reproduced or distributed in any form without express written permission from AACE.