Best Practices for E&M Coding Calculations

NextGen® Adaptive Content Engine Help Enterprise 8

Access the Practice Configuration Template

For more information on the Practice Configuration template, go to NextGen Healthcare Success Community, and download the latest Practice Configuration Template User Guide for NextGen® Adaptive Content Engine. From the File menu, select System \ Practice Template. The Select Template window opens. Click the Practice tab. If the Practice Configuration template is not in your Preferred templates list, in the Show section, select the All option. A list of practice templates appears. Select Practice Configuration Double-click Practice Configuration. The Practice Configuration template opens. Parent topic: Best Practices for E&M Coding Calculations

NextGen® Adaptive Content Engine Help Enterprise 8

Select E&M Coding Guidelines

Open the Practice Configuration template. In the E&M Coding section, do one of the following: Click in the 2021 Coding Effective Date. Then, select either the 95 Coding Guidelines or 97 Coding Guidelines option to use for visit types unaffected by the 2021 Coding Guidelines or for encounters before the effective date. Select the 95 Coding Guidelines option, and then select the physical exam calculation method. For more information, refer to Physical Exam Calculation for 95 Coding Guidelines section. Select the 97 Coding Guidelines option (default). For more information, refer to Physical Exam Calculation for 97 Guidelines section. Parent topic: Best Practices for E&M Coding Calculations

NextGen® Adaptive Content Engine Help Enterprise 8

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 latest 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 was spent counseling or coordinating care You can use either the 95 or 97 Coding Guide

NextGen® Adaptive Content Engine Help Enterprise 8

Submit E&M Codes under 95 or 97 Coding Guidelines

You can submit a calculated or selected E&M code to the Superbill under the 95 or 97 Coding Guidelines. Before you begin You must select an assessment in the Today’s Assessments panel to submit an E&M code. Open NextGen® Enterprise EHR. For a patient record, open a new encounter. Open the Finalize template. Expand the Evaluation and Management Coding panel. Evaluation and Management Coding To use a calculated E&M code, you can select the MDM level, or enter the total visit time. Enter any additional visit codes. To meet visit code criteria for Quality Reporting, select a SNOMED CT code. To override the calculated code, select an E&M code in the code options section at the bottom of the Evaluation and Management Coding panel. Note: The 99201 code cannot be selected as the code has expired on January 1, 2021. To generate a note, referral, lab order, requisition, or another document, select Generate Note and select an option. Select Submit Code. The code appears in the Submitted field. Th

NextGen® Adaptive Content Engine Help Enterprise 8

E&M Coding

The E&M Coding section of the Practice Configuration template displays Evaluation and Management configuration options that apply to all specialties except Cardiology. The Cardiology-specific E&M settings are available in the Cardiology E&M Guidelines section of the Practice Configuration template. For more information on E&M coding, go to NextGen Healthcare Success Community and download the latest E&M Coding User Guide for NextGen® Adaptive Content Engine. In the E&M Coding section, you can configure the following settings: E&M Coding section Guidelines - You can select the coding guidelines to use for E&M coding on the Finalize template. You can select either the 95 Coding Guidelines or 97 Coding Guidelines. To use the 2021 Coding Guidelines, you must enter the 2021 Coding Guidelines Effective Date. If you enter a date, you must also select the 95 or 97 Coding Guidelines to cover visit types not affected by the 2021 guidelines or for encounters before the effective date. If you sele

NextGen® Adaptive Content Engine Help Enterprise 8

Evaluation and Management Coding

You can use three types of guidelines to calculate the Evaluation and Management code for Cardiology. To submit a calculated or a selected Evaluation and Management (E&M) code on the Finalize - Cardiology template, you can use guidelines for 95, 97, or 2021 configured on the Practice Configuration template. The 95 and 97 Coding Guidelines calculate E&M codes based on one of the following. Previously documented history and physical exam details and the selected Medical Decision Making (MDM) level. Total visit time, if more than 50 percent of the time was spent counseling or coordinating care. The 2021 Coding Guidelines calculate E&M codes based on one of the following. The selected MDM level. Total time spent by medical professionals treating patients and documenting their care during the encounter, including the amount of face-to-face and other time they spend with patients. On the Practice Configuration template, if you select the 2021 Coding Guidelines, you must also select the 95 or

Best Practices for E&M Coding Calculations

Recommendations

Access the Practice Configuration Template

Select E&M Coding Guidelines

Evaluation and Management Coding

Submit E&M Codes under 95 or 97 Coding Guidelines

E&M Coding

Evaluation and Management Coding

Access the Practice Configuration Template

Select E&M Coding Guidelines

Evaluation and Management Coding

Submit E&M Codes under 95 or 97 Coding Guidelines

E&M Coding

Evaluation and Management Coding