E/M Reporting – Ortho Style

Event Information
Product Format
Prerecorded Event
Margie Scalley Vaught, CPC, CPC-H, CPC-I, CCS-P, PCE, MCS-P, ACS-EM, ACS-OR
Conference Date
Tue, Aug 07, 2018
60 minutes
Product Description

Documentation for a Given EM Level of Service – Why It’s Important

You’ve probably heard the saying, “not documented, not done” – and this is especially true when it comes to supporting a given Evaluation & Management (E/M) level of services. Now, HHS Office of Inspector General (OIG) and Recovery Audit Contractor (RAC) auditors are scrutinizing claims to root out lackluster documentation and “cloning.”

Learn what specifically you must have in your documentation to support a particular E/M level for the orthopedic specialty. Join orthopedic coding expert Margie S. Vaught, CPC, CPC-H, CPC-I, CCS-P, as she instructs you on how to properly code the correct E/M level of service with the documentation provided.

After attending this audio event, you will walk away with all the tools and knowledge you need to perfect your Ortho E/M coding and documentation, so you can keep OIG and RAC auditors at bay. Learn from specific examples from what orthopedic offices see on a daily basis, with examples of what coding 99214, 99213, and 99203 would actually look like regarding services provided and the documentation. You’ll also get information on the E/M Bell Curve from Medicare data for the orthopedic, hand, and podiatry specialties.

Session Highlights

This program will teach you how to:

  • Identify what is required in a History and who can obtain the History of Present Illness (HPI) elements
  • Determine whether you can support a comprehensive examination
  • Know what an “appropriate” examination is and when auditors would be suspicious of “cloning”
  • Determine how often you need to perform and/or update the complete Review of Systems (ROS)
  • Figure out whether you can support both the office visit and minor procedure, or whether you should let the E/M go
  • Spot the Medical Decision Making essentials – the “meat and potatoes” of your full documentation, so your payer, auditor, or carrier doesn’t down-code the E/M level

Session Agenda

  • New vs. established patients
  • Key components of history
  • History of Present Illness (HPI) importance
  • When do you need PFSH?
  • Examination elements
  • Rx drug management
  • EM issues

Who Should Attend

  • Coders
  • Billers
  • Office Managers
  • Practice Managers
  • Orthopedic Surgeons

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

Order Below or Call 1-844-384-4744 Today

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About Our Speaker

Margie Scalley Vaught - Wound Care Coding Expert

With over 30+ years’ experience in the Healthcare arena, in positions from nurse’s aide to ward clerk and medical transcriptionist to office manager, Margie Scalley Vaught, CPC, CPC-H, CPC-I, CCS-P, PCE, MCS-P, ACS-EM, ACS-OR, understands how offices are structured.  Margie spent twenty years in the field of Orthopedics.  She obtained Certified Professional Coder (CPC) designation in 1995 from the American Academy of Professional Coders (AAPC), where she served...   More Info
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