Assigning Evaluation and Management (E/M) Codes

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Assigning Evaluation and Management (E/M) Codes

By | May 2011
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CheckPoint Applying Level II HCPCS Procedure Codes

Administration of flu vaccine: Procedures and professional
Services G0000–G9999 G0008 Administration of influenza virus vaccine Comprehensive oral exam: Dental procedures D0000–D9999 D0150 Comprehensive oral exam Screening for hearing loss: Hearing services V5000–V5999 V5364 Dysphagia screening Cortisone 10 mg injection, right shoulder: Chemotherapy drugs J9000–J9999 J9212 Injection, interferon alfacon-1, recombinant, 1 mcg Alcohol and/or drug services; case management: Alcohol and drug abuse treatment services H0000–H9999 H0006 Alcohol and/or drug services; case management Single lens spectacle mounted low vision aids: Vision services V0000–V2999 V2020 Frames, purchases Ambulance waiting time: Transportation services A0000–A0999 A0300 Ambulance service; basic life support, nonemergency, all-inclusive Chest X-ray: Temp Code Q0000–Q0099 or Q0035 Cardi-screens and or tests Knee orthosis, elastic with stays: Orthotic procedures L0000–L4999 L1800 Knee orthosis (KO); elastic with stays Hospital bed with side rails and mattress: Durable medical equipment E0000–E9999 E0250 Hospital bed with side rails and mattress

*Has stated in Table 6.1 pg 190 of: Medical Insurance*
What is the importance of correctly linking procedures and diagnoses? What are the implications of incorrect medical coding?
How are medical coding, physician, and payer fees related to the compliance process?

It’s important to link procedures and diagnoses because if a patient received a diagnoses of say an allergic reaction to penicillin- but a procedure results in the patient getting penicillin then they could have another allergic reaction. If you don't have the correct codes than the patient or insurance can be billed wrong and either they pay tons of money out to procedures that didn't happen, or deny those that did. They can be significant: charges of fraud. As well as not recouping the correct reimbursement.

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