Author Topic: NJ PIP E/M GUIDELINES  (Read 2062 times)

mooreq

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NJ PIP E/M GUIDELINES
« on: July 28, 2009, 10:41:07 AM »
Hi,
I need to know the "official" guidelines for coding a new patient examination.  IE, if I have a 99203 or a 99204 level service, what exactly must be included.

NJ Manufacturers is saying that a full, computerized Range of Motion examination is to be performed within a 99203/99204 level examination.  The physician indicates that he can use an observed Range of Motion for the exam, and then do a separate procedure for the computerized testing (95851 per trunk section) on a different day.

The physician's code book says: "Routine muscle and range of motion testing is a component of a physical examination within the E/M service.  However, in such routine examinations there could be findings that indicate a need for more definitive and quantifiable data.  In such cases, these "separate procedure" codes are appropriate and accurate expressions."

so it boils down to this: can anyone help me find the official text describing the range of motion examination component for an E/M code so a chiro can use the observed range of motion on normal intake exams, and a separate ROM code on a subsequent visit
I have tried the NJ State site for banking and insurance.  They have a fee schedule but no info on what is to be included in E/M svc. codes.  Any guidance would help!

Thanks, JM
J

Michele

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Re: NJ PIP E/M GUIDELINES
« Reply #1 on: July 28, 2009, 09:03:15 PM »
This is a tough one.  I don't have an answer for you.  I hope we have another forum member with experience in this. 

Michele
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mooreq

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Re: NJ PIP E/M GUIDELINES
« Reply #3 on: July 30, 2009, 09:52:27 AM »
Thanks for the reply Philip!

Steve Verno CMBS, CEMCS

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Re: NJ PIP E/M GUIDELINES
« Reply #4 on: August 08, 2009, 09:06:49 AM »
Evaluation and Management Documentation Guidelines were published in 1995 AND 1997.  Thes two guidelines are industry standard and are mandated by HIPAA by CMS.  They are located here:

http://www.cms.hhs.gov/MLNEdwebGuide/25_EMDOC.asp

a 99203 and 99204 requies the three key components of the E/M:  History, Examination and Medical Decision Making. 
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