Practice Management Alert

Discussing test results, diagnoses often result in time-heavy E/Ms.

While there are no exact scenarios that will automatically trigger a chance at using the counseling exception for your evaluation and management (E/M) coding, there are some situations that are more likely than others in which coding with the counseling exception is possible.

According to Melanie Witt, RN, CPC, MA, an independent coding expert based out of Guadalupita, N.M., these might be counseling exception E/Ms, if the physician’s actions and documentation satisfy the exception requirements:

• Return visit to discuss test results
• Educating the patient about how to monitor her blood glucose levels after her initial visit diagnosed her diabetes
• Discussing with the patient or family (in the case of a minor) treatment options after a diagnosis of cancer.

Under the right circumstances, these encounters might also result in counseling exception E/Ms, according to Donelle Holle, RN, a healthcare, coding, and reimbursement consultant in Fort Wayne, Ind.:

• A patient presents with a chronic condition but is non-compliant with her medication and treatment plan and the physician has to counsel on the necessity for this treatment plan.
• An elderly patient presents with chronic issues and is confused on how to take his medication.  The patient’s daughter is present and the physician counsels both of them on the correct use of medication, gives advice to the daughter on how to monitor medication use, etc. The patient and daughter ask questions and leave with a better understanding of the importance of a medication schedule.
• A patient arrives with his parents as he is having bed-wetting issues. After a brief history and examination to identify any physical reasons for the behavior, the physician asks further questions of the parents and they discuss options and possible treatments. The counseling around the bed-wetting takes up the majority of the visit.

Remember: These are only examples of potential counseling exception E/Ms. Each encounter is different, and you should be sure that all of the counseling exception rules are met before employing this coding technique.