Evaluation and Management Coding is Manageable

Evaluation and Management Coding is Manageable

As chiropractic physicians, we use evaluation and management codes frequently, but not at every encounter, as do our medical counterparts.  These are the CPT® codes used to describe the work involved in figuring out what is wrong with a patient and creating a plan to manage him or her.

You might compare chiropractic care to a train.  The engine is the first evaluation, the cars are the subsequent treatment visits, and the caboose is the discharge evaluation.  Depending upon the duration of the care plan, you might need to insert a few update evaluations in amongst the cars as well.  If those occasions are significant and separately identifiable from the chiropractic manipulative treatment, an evaluation and management code would be appropriate then.

Evaluation and management codes have all kinds of rules and components.  They can be difficult to understand, especially when trying to apportion as much of your time as possible to working on your patients, rather than deciphering coding and documentation.  Fortunately, Dr. Gwilliam has waded through all the information out there and compressed it into chiro-specific training you can listen to as part of his presentation on October 6. You can also get a taste of the training at the 2017 ICS Chicago National Convention and Expo.  Dr. Gwilliam will be covering lots of topics from therapeutic procedure coding to surviving audits.  You won’t want to miss his session.

In the meantime, here are a few random tips to whet your evaluation and management appetite:

  • If you don’t document a Review of Systems, the highest Evaluation and Management code you can use is 99201 (or 99213 for established patients).
  • If you neglect to document Past, Family, and Social History, the highest E/M code you can use is 99202 (or 99214 for established patients).
  • Chiropractic physicians should rarely if ever, bill for high-level codes such as 99204 and 99215.  This is primarily because we do not see patients with a high enough type of Medical Decision Making based on the risk of morbidity and/or mortality. 
  • Chiropractic physicians should rarely, if ever, bill 99211 (aka the Nurses’ Code) because the work is almost always included in other codes we bill.  If we are indeed performing an evaluation, then we should consider the 99212 because the criteria are very easy to satisfy.
  • If you have a written request for an evaluation from an appropriate source, and you send the patient back to the source with a written report, you can bill for the more highly paid Consultation E/M code. 

There is a lot more to know, but at ChiroCode we have whittled it down to what really matters for DCs.  We are here to help. 

Evan M. Gwilliam, DC, CPC

Executive Vice President, ChiroCode

“CPT Copyright 2017 American Medical Association. All rights reserved.
CPT® is a registered trademark of the American Medical Association.”

About Author

Evan Gwilliam, DC, MBA, BS, CPC, NCICS, CCPC, MCS-P, CPMA

Dr. Gwilliam graduated from Palmer College of Chiropractic as valediction and is a Certified Professional Coding Instructor, Medical Compliance Specialist, and Certified Professional Medical Auditor, among other things. He now provides expert witness testimony, medical record audits, consulting, and online courses for health care providers.


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