New and Established Patients and Visit Types

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Overview of Evaluation and Management Coding

You can calculate and submit the E&M code. You can submit and calculate the Evaluation and Management (E&M) code from the Finalize template using the 95, 97, 2021 Guideline, or 2023 Coding Guidelines update based on the Practice Configuration template settings. The available E&M codes vary by specialty and visit type. If you do not want to charge a patient encounter, you can select the No Charge Visit checkbox in the Evaluation and Management Coding panel to submit a no-charge code. The No Charge Visit procedure group checkbox is configured by default. The No Charge Visit checkbox is available only if the no charge SIM code is configured to the No Charge Visit procedure group using the Manage Procedure Group and Codes template. For more information, go to NextGen Healthcare Success Community, and download the Manage Procedure Groups and Codes Practice Template for NextGen® Adaptive Content Engine. The 95 and 97 Coding Guidelines use the following E&M code calculation criteria: History

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

Obstetric Visit Types

The Obstetric (OB) visit types are very specific to the unique requirements for billing OB and prenatal visits. Use the OB Prenatal - Initial visit type to confirm and document the beginning of a pregnancy where the prenatal record has not been initiated. You can bill for the encounter using the standard E&M codes 99201–99215. Note: Effective January 1, 2021, code 99201 will be deactivated. Use the OB Prenatal visit type for encounters where you are using the prenatal record. The application tracks each encounter during the current pregnancy with the OB Prenatal visit type on a hidden field on the Home page. You can bill prenatal visits separately if a patient obtains a new insurance plan or changes providers, and/or other complications arise. The Finalize template adds the number of prenatal encounters that have been documented for the current pregnancy and calculates the appropriate prenatal E&M code. For the OB Prenatal and OB Postpartum visit types, you can select the Prenatal/Post

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Behavioral Health Billing on the Finalize Template

The Finalize template calculates the Evaluation and Management (E&M) code and submits the code to the NextGen® Enterprise PM application. The Evaluation and Management Coding panel on the Finalize template calculates the E&M code based on the elements documented or the amount of time documented when more than 50% of the visit is spent counseling and/or coordinating care. The system fills the Visit Code field with the suggested Current Procedural Terminology ( CPT® ) codes. You should review the suggested CPT® code prior to submitting the code for billing. When the practice selects the 97 Coding Guidelines option on the Practice Configuration practice template and the specialty is set to Behavioral Health, the system defaults to the 97 Single System Psychiatric exam guidelines for the following visit types: Family Consultation General Medical Exam Hospital Consult Medication Management without Psychotherapy Onsite Consult Psychotherapy - Individual with E&M Medication Management with Ps

NextGen® Ophthalmic Suite Help 2022.2

2023 E&M Coding Guideline Changes

You can use the new Evaluation and Management (E&M) codes and guidelines that are effective from January 1, 2023. Most of the E&M codes from various visit types, such as Consult, Home Visit, Domiciliary Visit, Nursing Facility Care, Emergency Department, Inpatient, are now inclusive of 2023 E&M guideline. A few E&M codes such as Observation Care and Prolonged Service are removed and redirected to the existing visit type codes. The E&M code calculation logic is based on the patient encounter date (greater or equal to January 1st, 2023) and the selected visit type on the Finalize - OPH template. With the 2023 Coding Guidelines update, the 99241 code is disabled, and the labels for the following codes are updated in the Consultation section of the EM Code panel on the Finalize - OPH template: 99242: Straightforward 20-29 mins 99243: Low 30-39 mins 99244: Moderate 40 -54 mins 99245: High greater than 55 mins medical decision making/counseling template For more information about practice se

NextGen Behavioral Health Suite Help 5.6

Behavioral Health E&M Coding Guidelines

To submit a calculated or a selected Evaluation and Management (E&M) code from the Finalize template, you can use 97 or 2021 E&M coding guidelines configured on the Practice Configuration template. The available E&M codes vary by specialties and visit types. The 97 E&M Coding Guidelines calculate the E&M code based on one of the following: History and physical exam elements that were documented on templates and the Medical Decision Making (MDM) level selected Total visit time if more than 50 percent of the time was spent counseling or coordinating care When you enter the effective date in the 2021 Coding Guidelines Effective Date field on the Practice Configuration template, you must also select either the 97 Coding Guidelines for use with visit types and encounters that do not fall under the 2021 E&M Coding Guidelines. The current E&M coding guidelines will be in effect until the set date. You can set any date, change, or remove the date at any time. NextGen® Behavioral Health Suite u

New and Established Patients and Visit Types

Recommendations

Overview of Evaluation and Management Coding

Finalizing Evaluation and Management Coding for an Encounter

Obstetric Visit Types

Behavioral Health Billing on the Finalize Template

2023 E&M Coding Guideline Changes

Behavioral Health E&M Coding Guidelines

New and Established Patients and Visit Types

Overview of Evaluation and Management Coding

Finalizing Evaluation and Management Coding for an Encounter

Obstetric Visit Types

Behavioral Health Billing on the Finalize Template

2023 E&M Coding Guideline Changes

Behavioral Health E&M Coding Guidelines