Counseling and Coordination of Care for Evaluation and Management Coding

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Finalizing Evaluation and Management Coding for an Encounter

Because the E&M guidelines are not always clearly defined, and comments cannot be included in the E&M calculations in NextGen® Adaptive Content Engine, the overall E&M level is only suggested. As the physician or provider performing the encounter, you must review and confirm the E&M code before you submit it for billing. The Finalize template calculates the E&M code based on the selected E&M coding guidelines on the Practice Configuration template. Under the 95 and 97 Coding Guidelines, the Finalize template offers the following functionality: The template totals the E&M components documented in the encounter. When you select Calculate Code, several stored procedures calculate the components. The application then suggests an E&M level for the encounter. You can override the suggested E&M level code by selecting an E&M code listed on the template. You can use the second and third visit code fields to enter additional E&M codes from a Service Category list or from lists you access throug

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Calculate E&M Codes under the 95 or 97 Coding Guidelines

You can calculate the Evaluation and Management (E&M) code under the 95 or 97 Coding Guidelines. You can base the E&M code calculation on the selected Medical Decision Making (MDM) level, documented history, and physical exam elements, or on the total visit time if more than 50 percent of the time was spent counseling or coordinating care. Open NextGen® Enterprise EHR. For a patient record, open a new encounter. Open the Finalize template. On Evaluation and Management Coding, do one of the following: To calculate the E&M code based on the MDM Level, documented history, and physical exam elements, select the level of complexity associated with the encounter in the Medical Decision Making section. For guidance in determining the level of complexity involved in MDM, you can select the View MDM Guidelines link and the level of risk associated with the encounter, select the View Risk link and refer to the details. To calculate the code based on the total visit time, do the following: Select

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Evaluation and Management Coding

NextGen® Adaptive Content Engine uses Evaluation and Management (E&M) coding guidelines from the Centers for Medicare and Medicaid Services (CMS) for the documentation and billing of E&M services because these protocols are the most stringent. CMS provides three sets of guidelines to calculate E&M codes: 1995 (95) Coding Guidelines 1997 (97) Coding Guidelines 2021 Coding Guidelines (effective January 1, 2021) The Cardiology template set does not use these calculation methods described. For information on E&M coding for the Cardiology specialty, go to NextGen Healthcare Success Community, and download the Cardiology User Guide for NextGen® Adaptive Content Engine. The 95 and 97 Coding Guidelines calculate E&M codes based on one of the following: Documented history and physical exam elements, and the selected Medical Decision Making (MDM) level Total visit time if more than 50 percent of the time spent counseling or coordinating care You can use either the 95 or 97 Coding Guidelines, dep

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Evaluation and Management Coding

NextGen® Adaptive Content Engine uses Evaluation and Management (E&M) coding guidelines from the Centers for Medicare and Medicaid Services (CMS) for the documentation and billing of E&M services because these protocols are the most stringent. Evaluation and Management Coding Overview of Evaluation and Management (E&M) coding guidelines. Physical Exam Calculation for 95 Coding Guidelines Methods of physical exam calculations for the 95 coding guidelines. Physical Exam Calculation for 97 Guidelines Multi- and single-system exam types under the 97 coding guidelines. Components of Evaluation and Management Coding Description of the components used in Evaluation and Management (E&M) coding for the selected guidelines.

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Calculate E&M Codes under 2021 Coding Guidelines

You can calculate the Evaluation and Management (E&M) code under 2021 Coding Guidelines in Evaluation and Management. You can base the Evaluation and Management (E&M) code calculation on the selected Medical Decision Making (MDM) level or total visit time. Open NextGen® Enterprise EHR. Open a patient record. Open the Finalize template. On the Evaluation and Management Coding panel, to calculate the E&M code based on the MDM level, review the pre-filled complexity level or manually select the level of complexity associated with the encounter in the Medical Decision Making section.The Medical Decision Making section displays the MDM level based on the calculated levels in the three tables in the Medical Decision - Making Elements panel. To change the MDM level, change the automatically-calculated MDM levels in the MDM tables, or by making corrections in the encounter chart note. For guidance on using the 2021 Coding Guidelines based on MDM level and time, select the information icon. For

NextGen® Ophthalmic Suite Help 2022.2

Calculate the E&M Code under 95 or 97 Coding Guidelines

Before you begin You must configure the 95 or 97 Coding Guidelines selected on the Practice Configuration practice template. For more information on the 95 and 97 Coding Guidelines, go to the NextGen Healthcare Success Community and download the latest E&M Coding User Guide for NextGen® Adaptive Content Engine. The '95 and '97 guidelines base the Evaluation and Management (E&M) code calculation on the selected Medical Decision Making (MDM) level and the documented history and physical exam elements or on the total visit time if more than 50 percent of the time was spent counseling or coordinating care. Open the Finalize - OPH template. If the patient was counseled, enter counseling and educational details and factors. Select the level of complexity associated with the encounter in the Medical Decision Making section. To calculate the code based on the total visit time, click the Total visit time (minutes) field, enter the total time in minutes, including counseling time, and click OK.

Counseling and Coordination of Care for Evaluation and Management Coding

Recommendations

Finalizing Evaluation and Management Coding for an Encounter

Calculate E&M Codes under the 95 or 97 Coding Guidelines

Evaluation and Management Coding

Evaluation and Management Coding

Calculate E&M Codes under 2021 Coding Guidelines

Calculate the E&M Code under 95 or 97 Coding Guidelines

Counseling and Coordination of Care for Evaluation and Management Coding

Finalizing Evaluation and Management Coding for an Encounter

Calculate E&M Codes under the 95 or 97 Coding Guidelines

Evaluation and Management Coding

Evaluation and Management Coding

Calculate E&M Codes under 2021 Coding Guidelines

Calculate the E&M Code under 95 or 97 Coding Guidelines