Part 3: 2023 Evaluation and Management Series by AMCI - Prolonged visits

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hello everyone and welcome to the AMCI E

M series we've designed this series to

break down the e m guidelines into

manageable

digestible nuggets to ensure that you

have the best possible learning

experience we encourage you to watch the

playbacks as many times as you need

until you fully grasp those guidelines

and if you're seeking CEUs

simply click the link in the description

to enroll in our online course

you didn't know I'm Mrs J the curriculum

director at AMCI and I'm absolutely

thrilled to be here with you today now

let's go ahead

and let's take a moment to introduce our

fantastic team

and we're going to start with Miss

Tamika she is our assistant curriculum

director and Resident

qhp yes she is a physician's assistant

now let's turn our attention to Mr

Sandeep who is also a lead instructor at

AMCI and he is our resident pharmacist

with a master's in pharmacy

and introducing our dedicated AMCI

approved interns Miss Dolly who holds

both cpca and CCS certifications

and last but not least

Miss jasmeet who has an MS and a medical

background as a CNA

and with such an incredible team by our

side we are excited to dive into these e

m guidelines together so without further

ado

let's get started on this journey

and this is a four-part e m series yes

we will discuss in part one the AMCI

annotation technique called Chun we're

going to teach you how to Chun your e m

section we're also going to learn to

code office visits and scoring the

medical decision making in part one in

part two we're going to discuss

inpatient coding Hospital observation

we're also going to talk about

consultations and emergency departments

part three we're going to talk about

Nursing Facility visits prolonged

services and part four this is where

we're gonna summarize all of it and

we're going to test your knowledge but

rest assured throughout the parts we

will be testing your knowledge and

finally keep in mind that we will

consider the 2023 guidelines and apply

them every step of the way now let's get

this started

admission and discharge on the same day

code series 99234

through

99236 let's take a look at the

guidelines

in the guidelines say

that this requires a minimum of two

encounters two encounters

on the same day an initial admission

encounter and another encounter that

being the discharge encounter

so I could see how people might think

that you need two codes you don't need

two codes you just need

an admission and discharge doesn't mean

you need two codes right

so the patient has to have been admitted

and discharged on the same day and the

documentation has to specify it now if

one accounter occurs

then select a code from 99

2 to 1 through 99223

what do you mean Mrs J

I think the example is going to really

be beneficial so let's go ahead and

let's review the Chun of 99234 through

99236

here it is remember this is same day

admit and discharge

for 99234 this is hospital inpatient or

observation care for the evaluation and

management of a patient including

admission and discharge on the same day

this is straightforward or low medical

decision making

45 minutes must be met or exceeded

99235 this is moderate level of medical

decision making 70 minutes must be met

or exceeded

in 99236 this is high level of MDM with

85 minutes must be met or exceeded

and

for services of 100 minutes or longer go

ahead and use prolonged Services codes

now

let's just get to it

let's go ahead and test

our knowledge and I think it's going to

make sense after

all right so our first scenario will be

read by miss jasmeet all right Miss

Jasmine take it away

thank you Mrs J so coders of the

following codes which best describes the

encounter a

99235b99222 c 9 9 2 2 1 and D

99234 Thomas arrived at the hospital at

5am Via ambulance after falling off a

ladder and sustaining loss of

consciousness for an unknown length of

time a comprehensive exam was carried

out then carried out then the patient

was placed on observation status

the patient is now conscious and

requires a concoction evaluation

Thomas remained in observation for eight

hours after which time the physician

re-evaluated the patient advised the

patient to see a neurologist for further

evaluation and treatment then discharge

the patient The Physician spent a total

time of 45 minutes with the patient of

the following codes which best describes

the encounter coders you have two

minutes to solve the scenario thank you

all right

here time's up

thank you so much Miss Jazz meet time's

up

loss of consciousness

a comprehensive exam

eight hours of observation total time of

the encounter was 45 minutes these are

our key words and you know your keywords

don't have to be exactly like mine you

might say all right I'm going to

highlight that reevaluated patient there

you go all right so the

next thing that we need to do

we need to know I need to revisit these

guidelines because the guidelines say

that in order for this to be a prolonged

Services encounter you need a minimum of

two encounters what do you mean

all right so you need one code for the

admission and in this case we have one a

comprehensive exam was carried out right

so there was an admission

also one code for the discharge then the

patient was discharged as you can see

there was a encounter that initial

patient exam took place and a discharge

so we do have a minimum of two

encounters and if you revisit the

guidelines it says it's required two or

more encounters on the same date of

which one of these encounters is an

initial admission encounter and the

other encounter is a discharge encounter

so I think it satisfies it

so our documentation says the total time

spent with this patient is 45 minutes so

I'm going to go to the front of my CPT

book I'm going to turn to the charts

and I'm going to locate hospital

inpatient or observation care services

including admission and discharge on the

same date

and then I'm going to look for well we

know that a medically appropriate

history and or exam took place a

comprehensive exam was carried out so

I'm going to go right to the bottom and

look for my minutes

and it's 45