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Chiropractic Research Review

Understanding Medicare's New E/M Guidelines

Evaluation and management (E/M) codes required for Medicare documentation have undergone significant changes in the past decade. Based upon case complexity, as defined by the Current Procedural Terminology, the E/M codes are now based on resource-based relative value scales (RBRVS).

RBRVSs reflect the amount of work and resource costs expended by the clinician in evaluating a patient, as opposed to the old method, which counted the amount of time used during evaluation.

The new guidelines, released in June 1999 by the Health Care Financing Administration (HCFA), provide explicit description of clinical documentation requirements for E/M, and also serve as a template for audits of E/M services by HCFA. While chiropractors are not reimbursed for E/M services by HCFA proper, the recognition by HCFA that DCs provide these services has provided information for regional managed care carriers to use in making reimbursement decisions. As such, this information impacts the clinical practice of chiropractors receiving reimbursement from such carriers.

Although the new guidelines are clinically logical and reflect good practice habits, there is a learning curve associated with understanding these parameters, necessary to provide effective and efficient chart documentation. This article reviews the Medicare documentation requirements and provides detailed explanations and case examples of what doctors can do to accurately document patient assessment services.
Numerous tables are included to help clinicians understand the following:

* categories of E/M codes;
* the purpose of individual code categories;
* how to evaluate and manage office/outpatient service levels; and
* how to select and document patient history and examination levels.

Several documentation checklists that are immediately applicable in practice are also included as appendices to this article. Despite their complexities, the new E/M guidelines will be the standard for Medicare audits. DCs using these codes with regional Medicare and private- sector payers can expect to be held to these documentation standards.

Note: While it is always tedious, and often difficult to implement new practice standards in an office with established standard operating procedures, this article serves as an excellent tutorial and practice aid to achieve this goal. Chiropractors should find this article extremely useful for training office staff or for staff in-service meetings.

Hoffmann B, Donahue RT, Mootz RD. A user's guide to evaluation and management codes. Topics in Clinical Chiropractic 2000:7(3), pp58-68.
Reprints: (800) 638-8437

Chiropractic Research Review

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