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27-Jul-2017 06:54

Note: This interactive worksheet was created as a tool to assist providers and is not intended as a replacement for the 19 E/M documentation guidelines published by the Centers for Medicare & Medicaid Services (CMS).https://com/EM/165590Billing Guide CPT code 99499 Reporting CPT code 99499 (Unlisted evaluation and management service) should be limited to cases where there is no other specific E/M code payable by Medicare that describes that service.Evaluation and Management Service Codes - General (Codes 99201 - 99499) A.Use of CPT Codes Advise physicians to use CPT codes (level 1 of HCPCS) to code physician services, including evaluation and management services.The purpose of this interactive worksheet is to assist providers with identifying the appropriate E/M code based upon either the 1995 or 1997 Documentation Guidelines for Evaluation and Management Services.Since the 19 guidelines each specify different criteria to determine the level of E/M service performed, only one set of guidelines may be used to document a specific patient visit.Medicare will pay for E/M services for specific non-physician practitioners (i.e., nurse practitioner (NP), clinical nurse specialist (CNS) and certified nurse midwife (CNM)) whose Medicare benefit permits them to bill these services.A physician assistant (PA) may also provide a physician service, however, the physician collaboration and general supervision rules as well as all billing rules apply to all the above non-physician practitioners.

The physician and the qualified NPP must be in the same group practice or be employed by the same employer.The split/shared E/M visit applies only to select E/M visits and settings (i.e., hospital inpatient, hospital outpatient, hospital observation, emergency department, hospital discharge, office, non-facility clinic visits and prolonged visits associated with these E/M visit codes).