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
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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 and health issues recorded on health records and death certificates. ICD supports the basis for the collection of national mortality and morbidity statistics by the World Health Organization (WHO). ICD is also utilized for reimbursement for services provided by the APRN (International Classification of Diseases, 2015).
Thorough medical record documentation by the APRN maximizes reimbursement for services rendered. The medical record should be complete and legible, documenting each patient encounter. The encounter includes the purpose of the visit, health history, physical exam, previous
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