The Classification Of E & M Services

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by an APRN fall within the APRN’s scope of practice under their state law. Commercial third-party payers do not consistently provide reimbursement for the APRN; however, their rates and policies differ (Buppert, 2005). The APRN submits either current procedural terminology (CPT) codes or evaluation and management (E&M) codes for Medicare reimbursement. CPT codes are a systematic listing and coding of procedures or services performed by the APRN. The American Medical Association (AMA) establishes, maintains, and copyrights the CPT codes. The five-digit number allocated to each code indicates a particular service or procedure. CPT codes provide a consistent description of the services rendered that is shared between medical…show more content…
Comprehensive is a general multi-system examination or complete examination of a single organ system and other symptomatic or related body area or organ system. The type and extent of the examination is determined by clinical judgment, patient’s history, and nature of the problem. The classification of E&M services endorse four types of clinical medical decision making: straightforward, low complexity, moderate complexity, and high complexity. Clinical decisions refer to the complexity of establishing a diagnosis or choosing a management option. The complexity is determined by the volume of possible diagnoses or management options, and the volume or complexity of medical records, diagnostic tests, or other information that must be obtained, reviewed, and analyzed. The risk of complications, morbidity or mortality, and comorbidities associated with the patient 's problem, the diagnostic procedure or management options also determines the classification of medical decision making (Department of Health and Human Services, Centers for Medicare & Medicaid Services, 2014b). The International Classification of Diseases (ICD) is the standard diagnostic tool for epidemiology, health management and clinical purposes. ICD includes the evaluation of the overall health conditions of populations and is used to surveil the incidence and prevalence of diseases and other health issues. ICD is used by the APRN to classify diseases
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