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E/M NGS Coding Changes

Provided by:  Jennifer Kirschenbaum, Esq.

June 6, 2017

 

Hi Jennifer:
 
National Government Services (NGS) made changes to the 1995 Documentation Guidelines. This impacts the documentation and coding for E/M services for all providers.

Please feel free to share this blog with your clients as well as the Free webinar  which will explain the changes. They can register for the Free Webinar on June 14, 2017 at 1pm-2pm on “ NGS Changes to the 1995 Documentation Guidelines”  They can register at our website www.medcoconsultants.com
 
 
Jacqueline Thelian, CPC, CPC-I, CHCA
ICD-10-CM Certified Trainer
Medco Consultants, Inc.
PO Box 650474
Fresh Meadows, NY 11365-0474
Phone: 718-217-3802  Fax: 718-217-4236
Email: JacquelineT@medcoconsultants.com
www.medcoconsultants.com

 

Medco Consultants, Inc.
By Lorna Simons, CPC
 
NGS Changes E/M requirements for Expanded Problem Focused and Detailed Examinations
 
On March 16, 2017 National Government Services (NGS), a Medicare Administrative contractor (MAC), announced changes to documentation requirements for expanded problem focused and detailed examination. These changes, based on the 1995 documentation Guidelines, will make it more challenging to achieve higher levels of service for providers in in this MAC.
 
Under the new updates the definition of expanded problem focused and detailed exam has been updated to include more body areas/ organs systems. An “expanded problem focused” exam will be defined as 2-5 body areas or organ systems. A “detailed” exam has been changed to include 6-7 body areas or organ systems. Per NGS, the changes were made in response to provider requests for clarification on the current examination requirements.
 
 

Changes in CPT coding E/M Requirements
  Current Requirements Requirements Effective July 1
Expanded Problem Focused 2-7 Body Areas/organ systems
(minimal detail/ check list type)
2-5 Body Areas/organ systems
Detailed 2-7 Body Areas/organ systems
(requiring more than checklists)
6-7 Body Areas/organ systems

 
 
 
NGS currently administers the Medicare Part A (hospital insurance) and Part B (medical insurance) contracts for the following states: Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont, and Wisconsin. For medical service providers in these states, the changes will be effective on July 1, 2017. 
 
Sources:
https://www.ngsmedicare.com/ngs/portal/ngsmedicare/newngs/home-lob/footer/about-us/
https://www.ngsmedicare.com/ngs/portal/ngsmedicare/newngs/home-lob/news-alerts/news-articles/news-detail/changes%20in%20cpt%20coding%20em%20requirements
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/95Docguidelines.pdf


 


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