Evaluation and Management Coding

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

Physical Exam Calculation for 95 Coding Guidelines

If your practice chooses the 95 Coding Guidelines option in the E&M Coding section of the Practice Configuration template, you must select one of two physical exam calculation methods associated with the guidelines. Detailed Numeric Strict Numeric Show Information for the 95 Physical Exam Calculation Methods You can display information comparing the physical exam level calculations under the 95 Coding Guidelines using Detailed Numeric and Strict Numeric methods. Detailed Numeric Exam Coding Thresholds for 95 Coding Guidelines Thresholds that must be configured under the 95 Coding Guidelines Detailed Numeric method Strict Numeric Exam Method for 95 Coding Guidelines Types of calculations and methods under the 95 Coding Guidelines Strict Numeric method. Single-organ System Exam Thresholds for 95 Coding Guidelines Overview of single-organ system exams Detailed Exam 4 x 4 Method for 95 Coding Guidelines Overview of the 4 x 4 Detailed Exam method under the 95 Coding Guidelines Parent topic:

NextGen® Adaptive Content Engine Help Enterprise 8

2021 E&M Coding Updates

NextGen® Adaptive Content Engine uses Evaluation and Management (E&M) coding guidelines under 2021 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 Under 2021 Coding Guidelines Overview of 2021 Coding Guidelines for Evaluation and Management Coding Related concepts Evaluation and Management Coding Under 2021 Coding Guidelines

NextGen® Adaptive Content Engine Help Enterprise 8

Finalizing E&M 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 codes 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

Best Practices for E&M Coding Calculations

Your practice must configure the guidelines and other settings to use for E&M calculations in the E&M Coding section on the Practice Configuration template. To meet the specific and unique needs of your practice, NextGen Healthcare strongly recommends that your practice perform a thorough audit of the E&M calculation process on your database prior to implementing the electronic submission of charges from NextGen® Adaptive Content Engine. To choose between the 95 and 97 Coding Guidelines, you can perform detailed audits of different visit types using both the 95 and 97 settings as well as both of the 95 calculation methods. The audits should provide the necessary details to make an informed final decision and ensure that your practice agrees with the suggested E&M levels calculated on the Finalize template. Access the Practice Configuration Template You can open the Practice Configuration practice template in NextGen® Enterprise EHR to configure E&M Coding Guidelines. Select E&M Coding

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

Evaluation and Management Coding

Recommendations

Evaluation and Management Coding

Physical Exam Calculation for 95 Coding Guidelines

2021 E&M Coding Updates

Finalizing E&M Coding for an Encounter

Best Practices for E&M Coding Calculations

Submit E&M Codes under 95 or 97 Coding Guidelines

Evaluation and Management Coding

Physical Exam Calculation for 95 Coding Guidelines

2021 E&M Coding Updates

Finalizing E&M Coding for an Encounter

Best Practices for E&M Coding Calculations

Submit E&M Codes under 95 or 97 Coding Guidelines

Evaluation and Management Coding