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    Barb Pierce, CCS-P, ACS-EM

    Evaluation and Management (E&M) service codes and other Current Procedural Terminology (CPT) codes commonly used by infectious diseases specialists are prone to frequent billing and coding errors. Some of the errors are due to the subjective nature of picking the right code level for E&M service codes, and other errors may be due to a lack of familiarity with the rules governing inpatient consultations, subsequent hospital visits, prolonged services, and incident-to billing.   

    IDSA has partnered with a coding expert, Barb Pierce, to help you get answers to your tough coding questions. Barb is a certified professional coder with extensive knowledge of CPT and ICD coding. She is a recognized national speaker on the E&M documentation guidelines and she has presented at several IDSA meetings and webinars as well as worked with ID practices to perform medical record reviews and coding education.

    Also checkout IDSA's Billing and Coding webpage for information on how to bill for outpatient infusions, care plan oversight, and immunizations.  

     
     BarbPierce 
     

I'm going to assume this is a Medicare patient.  Basically, Medicare took away the "intent" of the service when they decided to no longer pay for consultations.  So, technically, you could use the initial service codes in either situation.  However, if you are planning to follow the patient in the nursing home, then I'm guessing you don't have the medical necessity to do what is required of an initial code which requires at least a detailed history and a detailed exam, so I think a subsequent visit may be more appropriate.  On the other hand, if you don't plan to follow the patient and you are called for what used to be considered a consultation, then go with the initial nursing home codes. 

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