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Activity Provided By:

American Association of Colleges of Pharmacy

Unlock the Secret to E/M Coding

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Overview / Abstract:

Evaluation and Management (E/M) codes are the most commonly billed codes. Although there are guidelines to proper E/M code selection, Medical Necessity is the primary driver of correct coding. We are told that a physician may take a full history and provide a full physical, but without medical need to back it up … we should select a lesser code. For example, a resolved contact dermatitis with no other problem or complaint, is not a Level Five service because there is no need for a full Level Five service. It is a coder’s responsibility to verify that the diagnosis in the chart supports the procedure being billed. The question becomes: How does a coder, who is not a medical peer, challenge the questions of Medical Necessity when the reason for the services are NOT so black and white? And, the largest gray area, what supports a Level Three versus a Level Four? This workshop will provide you with the insights necessary to unlock the secret of accurate E/M coding by introducing the skills to accurately identify and effectively address Medical Necessity concerns.

This workshop is designed to make the topic of Medical Necessity less intimidating for coders. It also teaches you how to connect with documenting physicians to make E/M coding easier, audit ready, and accurate for fair payment. Maybe even ... fun!

In this workshop, you will learn:

Three little known secrets to accurate E/M coding
The definitions of Medical Necessity, to enable accurate coding
Documentation guidelines
How to clinically differentiate E/M service levels
Effective techniques for communication with physicians regarding Medical Necessity


Sep 02, 2020


Informatics / Coding / Billing CE





Credits / Hours


Presenters / Authors / Faculty

Stephanie joined Aviacode in 2012 where she continues her commitment to best serve the revenue cycle management needs of physicians and the healthcare community. She is an executive level healthcare operations expert with significant & broad ambulatory healthcare business experience with emphasis on multi-specialty physician groups, hospitals and payers. She has extensive experience in using data to drive payer audits. Stephanie has developed E/M audit selection algorithms to identify physician coding errors and recoup overpayments for both federal and commercial payers. She brings more than eighteen years’ involvement in healthcare regulations including: coding and billing compliance, HIPAA privacy, security, and transactions, and HITECH meaningful use compliance. Previously, Stephanie served as SVP at the American Society of Health Informatics Managers, working to fill the needs of physicians adopting Health IT and at its sister organization, AAPC as VP, Product Management. In prior roles she served as Chief Audit Officer for Parses, assuring physician audit accuracy and quality control for payer driven recovery audits of professional fees and was responsible for driving sales & managing new audit programs. As a public speaker and published writer, she is a nationally respected advocate of fair and proper payment for medical services.

Keywords / Search Terms

American Association of Colleges of Pharmacy

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