The Classification Of E & M Services

1308 Words Dec 19th, 2015 6 Pages
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 practitioners, patients, and third parties. CPT codes dictate the amount of reimbursement to be paid to the APRN (Wound, Ostomy and Continence Nurses Society, 2012).
According to the Department of Health and Human Services, Centers for Medicare & Medicaid Services (2014b), the classification of E&M services are based on four types of examination: problem focused, expanded problem focused, detailed, and comprehensive. Problem focused is a limited examination of the affected body area or organ system. Expanded problem focused is a limited examination of the affected body area or organ system and any other symptomatic or related body area or organ system. Detailed is an extended examination of the affected body area or organ system and any other…
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