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New AAFP President Thrives on Relationships, Problem Solving

Sep 25, 2013 - AAFP President Reid Blackwelder, M.D., of Kingsport, Tenn., is a glass-half-full kind of guy who isn't afraid of confronting challenges head on, and he thrives on finding solutions. In a recent interview with AAFP News Now, Blackwelder says he is prepared to lead the Academy into a new ...

AAFP News : Inside the Academy

https://www.aafp.org/news/inside-aafp/20130925blackwelderqa.html

NEWS NOW

...and Medicaid Services’ (CMS’) final 2011 Medicare conversion factor, the average payment rate for current procedural termi- nology (CPT) code 99213-commonly used by family physicians-will increase this year even though the numeric value of the conversion factor has been reduced. As...

American Family Physician

https://www.aafp.org/afp/2011/0201/p239.pdf

Opting Out of Medicare: How to Get Out and Stay Out

...Established Patient E/M ChartLevel 1 Level 2 Level 3 Level 4 Level 5 Office/OP 99211 (5 min) 99212 (10 min) 99213 (15 min) 99214 (25 min) 99215 (40 min) -OR- See below for billing by time factor. 1995 Basic Evaluation and Management Codes Coding Reference Card Evaluation and...

Family Practice Management

https://www.aafp.org/fpm/2017/1100/p17.pdf

p11.pdf

...appropriate problem-oriented office visit code (e.g., 99213 or 99214) with modifier 25 may be billed if the services are documented. It is important to remember that routine physicals (comprehensive, head-to-toe exams) are not covered by traditional Medi- care. If a Medicare...

Family Practice Management

https://www.aafp.org/fpm/2012/0900/p11.pdf

p11.pdf

...99213 Expanded problem focused 10060 I and D abscess, single Scalp, neck, hands, feet, genitals 17270 _______ 17271 _______ 17272 _______ 17273 _______ 17274 _______ 17276 _______99214 Detailed 10061 I and D abscess, complex or multiple 99215...

Family Practice Management

https://www.aafp.org/fpm/2013/0100/p11.pdf

p12.pdf

...the initial TCM visit but before the 30 days are up, you can still bill for that visit but will need to use an E/M office visit code such as 99213 or 99214. Additional E/M services, including preven- tive services, provided on the same day as the face-to-face TCM visit cannot be...

Family Practice Management

https://www.aafp.org/fpm/2013/0500/p12.pdf

p17.pdf

...the physician spends at least 15 minutes of face-to-face time with the patient and the majority of that time involves counseling, then code 99213 could be reported (since 15 minutes is the typical time associated with that code). In contrast, using the key components to determine...

Family Practice Management

https://www.aafp.org/fpm/2008/1100/p17.pdf

p18.pdf

...• 99211, 2.14 percent • 99212, 14.89 percent • 99213, 66.13 percent • 99214, 15.79 percent • 99215, 1.04 percent 10 Steps to a Patient-Centered Medical Home AnTon J. Kuzel, MD, MHPe Downloaded from the Family Practice Management Web site at www.aafp.org/fpm. Copyright© 2009...

Family Practice Management

https://www.aafp.org/fpm/2009/1100/p18.pdf

p19.pdf

...works here because if the practice gets $45 for both a 90-minute visit and a 20-minute visit, this will equate to the mean charge for a code 99213, the average level of service for a visit at a traditional practice. ➤ the practice does not contract with insurance companies....

Family Practice Management

https://www.aafp.org/fpm/2007/0600/p19.pdf

p21.pdf

...(99213) visits - differences that can have a surprisingly significant effect on your bottom line if you don’t understand them well. For example, the 2007 Medicare allowance (not adjusted for geographic differentials) for a 99212 is $37.14, while the allowance for a 99213 is $59.50....

Family Practice Management

https://www.aafp.org/fpm/2007/0100/p21.pdf

p22.pdf

...Take a look at From the presenting problem to the code on page 24. The tables show how the requirements for 99213-99215 and 99203-99205 look if you start from the presenting problem, assume that the other decision- making requirements are met and work toward the exam Coding From...

Family Practice Management

https://www.aafp.org/fpm/2008/1100/p22.pdf

p23.pdf

...CPT code: 99213 for an established patient or 99202 for a new patient. Diagnosis: 307.81 (tension headache). Concerns. Documentation does not indicate whether this is a new or established patient. This detail should be included in a heading or in the body of the note so that...

Family Practice Management

https://www.aafp.org/fpm/2013/0700/p23.pdf

p30.pdf

...For example, the report shows that Physician A reports code 99213 almost three times as often as code 99214, although the benchmark ratio is 1.08:1. There are no Medicare wellness visits or transitional care management services reported. There are no smoking cessation services or...

Family Practice Management

https://www.aafp.org/fpm/2016/0500/p30.pdf

p31.pdf

...Stuck on 99213 Selecting and documenting appropriate levels of E/M services can be challenging for many physicians. Often, code 99213 becomes the default code because physicians think exten- sive documentation will be needed for coding anything higher and they believe 99213 is...

Family Practice Management

https://www.aafp.org/fpm/2011/0300/p31.pdf

p33.pdf

...status of chronic diseases). A brief HPI includes documentation of one to three of these elements and is consistent with E/M codes 99212 and 99213. Since this is a follow-up visit for well-controlled chronic condi- tions, the HPI doesn’t meet the level of an extended HPI, which...

Family Practice Management

https://www.aafp.org/fpm/2011/0900/p33.pdf

p39.pdf

...percent of established patient visits were reported as 99212 - a decrease of almost 50 percent. During the same four-year period, the use of 99213 decreased by about 7 percent and the use of 99214 increased by about 60 percent. The increased use of electronic health records...

Family Practice Management

https://www.aafp.org/fpm/2007/0400/p39.pdf

p40.pdf

...3. Know the E/M documentation guidelines. A 99213 level of service does not require a comprehensive review of systems or a comprehensive exam. Document what’s medically necessary and complete for today’s visit, and no more. (For more information, see the FPM Docu- mentation...

Family Practice Management

https://www.aafp.org/fpm/2016/0300/p40.pdf

p43.pdf

...patient primarily for management of diabetes, ICD-9 code 250.90 (diabetes type II with unspecified complications), would be diagnosis 1, and 99213 and 85018 (A1C test) would be marked with number 1 in the Rank column. If the patient also complains of a sore throat, the related...

Family Practice Management

https://www.aafp.org/fpm/2006/0900/p43.pdf

Planning Group Visits for High-Risk Patients -- FPM

Jun 1, 2000 - You'll not only have more satisfied patients and better compliance, but you'll also be compensated for your services.

Family Practice Management : Articles

https://www.aafp.org/fpm/2000/0600/p33.html

Potential pitfall in Medicare billing: psychotherapy in conjunction with an evaluation ...

May 30, 2014 - Potential pitfall in Medicare billing: psychotherapy in conjunction with an evaluation and management service

Family Practice Management : Getting Paid Blog : FPM Home

https://www.aafp.org/journals/fpm/blogs/gettingpaid/entry/potential_pitfall_in_medicare_billing.html

Practice Essentials -- FPM Topic Collection

Nov 8, 2011 - If you want a quick course on those aspects of practice that you didn't learn about in medical school and residency, or if you're new to practice and feeling overwhelmed, this Practice Essentials article collection will introduce you to the basics -- from coding to contracting to time ...

Family Practice Management : Topic Collections

https://www.aafp.org/fpm/topicModules/viewTopicModule.htm?topicModuleId=74

Practice Management and Leadership handouts

...99213 Expanded problem-focused Expanded problem-focused Low Complexity 99214 Detailed Detailed Moderate Complexity 99215 Comprehensive Comprehensive High Complexity New Patient ● Has not received any professional services from the physician, or another physician of...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx18-practice-management-leadership-handout.pdf

Primary Care Exception Needs Expansion, AAFP Tells CMS

Oct 14, 2019 - In an Oct. 9 letter to CMS, the Academy advocated for the expansion of codes under the primary care exception rule -- an update that would reduce administrative complexity without compromising patient care.

AAFP News : Government and Medicine

https://www.aafp.org/news/government-medicine/20191014exceptionrule.html

Quality Measurement: A Long Way to Go -- FPM

Aug 1, 2018 - Physician quality shouldn't be subjective. But the current measurement methods need more work.

Family Practice Management : From the Editor

https://www.aafp.org/fpm/2018/0700/p4.html

Resolution No. 305 (Virginia C) - Request the AAFP to Work with Insurers to Reduce the ...

May 7, 2015 - This resolution asks that the AAFP collaborate with the American Medical Association (AMA), America’s Health Insurance Plans (AHIP), and other appropriate stakeholders to develop and implement best practices for the standardization of the prior authorization process across managed care ...

About AAFP : Organizational Leadership

https://www.aafp.org/about/governance/congress-delegates/previous/2014/resolutions/virginia-c.mem.html

Resolution No. 306 (Ohio A) - AAFP Action on Prior Authorization Policies -- 2014 ...

Nov 13, 2014 - This resolution asks that the AAFP meet with private and government insurers to discuss solutions that would decrease the large administrative burden involved with prior authorizations.

About AAFP : Organizational Leadership

https://www.aafp.org/about/governance/congress-delegates/previous/2014/resolutions/ohio-a.mem.html

Same-Day E/M Services: What to Do When a Health Plan Won't Pay -- FPM

Apr 1, 2006 - These ideas will help you deal with the difficult consequences of this common policy.

Family Practice Management : Articles

https://www.aafp.org/fpm/2006/0400/p58.html

Same-Day E/M Services: What to Do When a Health Plan Won’t Pay -- Family Practice ...

...Problem-oriented service 99213 $75 $40 (80 percent of Medicare allowable) $10 (20 percent of Medicare allowable) Totals $260 $40 $110 It may help to remind the patient that you implemented your policy in response to the patient’s health plan’s decision. 62 | FAMILY...

Family Practice Management

https://www.aafp.org/fpm/2006/0400/p58.pdf

Senate and House of Representatives

...each component of a multiple-component vaccine. In other news related to CPT codes, recent data show that Medicare allowances for CPT codes 99213 and 99214 have seen a slow but steady cumulative rise of 42 and 35 percent, respectively, over the past six years. The increase in...

American Family Physician

https://www.aafp.org/afp/2011/0101/p19.pdf

Sep 2005

...Coding "Routine" Office Visits: 99213 or 99214? Peter R. Jensen Departments From the Editor New and Improved for You Leigh Ann Backer Editorial Ten Hard Questions About the Future of the Specialty Douglas Iliff Letters • Taking Care of Children • Is...

Family Practice Management

https://www.aafp.org/fpm/2005/0900/

Services Not Covered by Medicare -- Physician Payment

Aug 10, 2018 - Learn about the two categories of services not covered by Medicare, including services not deemed medically reasonable or necessary and non-covered services.

Practice Management : Payment for Physicians

https://www.aafp.org/practice-management/payment/coding/non-covered-services.html

Should You Modify Your Use of Modifiers? -- FPM

May 1, 1999 - This article explains how to use modifiers commonly attached to CPT codes for family physicians' services.

Family Practice Management : Q&As

https://www.aafp.org/fpm/1999/0500/p18.html

Six keys to coding 99211 visits -- FPM

Aug 20, 2018 - Using CPT code 99211 can boost your practice’s revenue and improve documentation. Here's how to determine if a service qualifies.

Family Practice Management : In Practice Blog : FPM Home

https://www.aafp.org/journals/fpm/blogs/inpractice/entry/coding_99211.html

Skin Care Encounter Form

...99213 Expanded problem focused 95044 Patch tests _____________ # of tests 99214 Detailed 11102 Tangential skin biopsy, single 99215 Comprehensive [ ] Procedure only +11103 Tangential biopsy, each add’l (#)______ 99024 Post-op care 11104 Punch skin biopsy, single New...

Family Practice Management

https://www.aafp.org/fpm/2013/0100/fpm20130100p11-rt1.pdf

Skin Deep: How to Properly Code for Biopsies and Lesion Removal

...99213 Expanded problem focused 11901 Intralesional injection, > 7 lesions 99214 Detailed 95044 Patch tests ____________ # of tests 99215 Comprehensive  Procedure only 11102 Tangential skin biopsy, single 99024 Post-op care +11103 Tangential biopsy, each add’l (#)____ New...

Family Practice Management

https://www.aafp.org/fpm/2019/0300/p15.pdf

Sneak Preview of the (Revised) Revised E/M Documentation Guidelines -- FPM

Sep 1, 1999 - The more you learn about them now, the better prepared you'll be when they hit.

Family Practice Management : Articles

https://www.aafp.org/fpm/1999/0900/p43.html

Splinting, Casting, and Wrapping with Online Module Presentation

...• Use CPT for E/M Service same day as procedure-eg. 99213-25 (E/m plus modifier) • Consider using Fracture Care codes-eg. 26600 References • The Clinics Atlas of Office Procedures, Guest editors, Petrizzi, Michael J., and Petrizzi, Mark G., Sept. 2002, Vol. 5, No. 3. •...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx19-431-432.pdf

start-a-practice.xlsx

...99213 15 minutes $ 96.00 $ 98.00 $ 100.00 $ 73.00 $ 58.00 $ 15.00 $ 80.00 44% 43% 880 $ 76,384.00 99214 25 minutes $ 141.00 $ 130.00 $ 150.00 $ 107.00 $ 86.00 $ 20.00 $ 120.00 43% 49% 860 $ 107,672.00 99215 40 minutes $ 190.00 $ 180.00 $ 185.00 $ 144.00 $ 115.00 $ 20.00 $...

Practice Management

https://www.aafp.org/dam/AAFP/documents/practice_management/restricted/start-a-practice.xlsx

start-a-practice.xlsx

...99213 15 minutes $ 96.00 $ 98.00 $ 100.00 $ 73.00 $ 58.00 $ 15.00 $ 80.00 44% 43% 880 $ 76,384.00 99214 25 minutes $ 141.00 $ 130.00 $ 150.00 $ 107.00 $ 86.00 $ 20.00 $ 120.00 43% 49% 860 $ 107,672.00 99215 40 minutes $ 190.00 $ 180.00 $ 185.00 $ 144.00 $ 115.00 $ 20.00 $...

Practice Management

https://www.aafp.org/content/dam/AAFP/documents/practice_management/restricted/start-a-practice.xlsx

Ten Steps to a Patient-Centered Medical Home -- FPM

Dec 1, 2009 - Start with steps that increase practice revenue. Then you'll be better able to afford the steps that just make practice better and more satisfying.

Family Practice Management : Articles

https://www.aafp.org/fpm/2009/1100/p18.html

Test Your Coding Skills -- FPM

Feb 1, 2002 - Go head to head with our review panel in coding six troublesome progress notes.

Family Practice Management : Articles

https://www.aafp.org/fpm/2002/0200/p41.html

The 1997 Evaluation and Management Guidelines at a Glance

...99213 EPF EPF LC 15 min. 99214 D D MC 25 min. 99215 C C HC 40 min. 2 of 3 required THE 1997 EVALUATION AND MANAGEMENT GUIDELINES AT A GLANCE 2 of 2 Exam Systems/Areas Bulleted elements PF 1+ 1-5 EPF 1+ 6-11 D 2+ 12+ C 9+ 18+ Note: For the...

Family Practice Management

https://www.aafp.org/fpm/2011/0900/fpm20110900p33-rt1.pdf

The 2019 Medicare Documentation, Coding, and Payment Update -- FPM

Feb 1, 2019 - This year’s changes include some welcome documentation relief, new codes for portal and telephone encounters, and much more.

Family Practice Management : Articles

https://www.aafp.org/fpm/2019/0100/p23.html

Think 99214 if you see these problems or procedures -- FPM

Jun 20, 2019 - The risk component of medical decision making is more subjective and can be difficult to identify, so here’s what to look for.

Family Practice Management : In Practice Blog : FPM Home

https://www.aafp.org/journals/fpm/blogs/inpractice/entry/99214_presenting_problems.html

Time is of the Essence: Coding on the Basis of Time for Physician Services -- Family ...

...are summarized on page 30. For example, according to CPT, a 99203 office visit typically requires 30 min- utes of a physician’s time, while a 99213 office visit requires 15 minutes on average. When time can be used as the basis for selecting the right code, there is some debate...

Family Practice Management

https://www.aafp.org/fpm/2003/0600/p27.pdf

Time Is of the Essence: Coding on the Basis of Time for Physician Services -- FPM

Jun 1, 2003 - Sometimes, coding is almost as simple as looking at the clock.

Family Practice Management : Articles

https://www.aafp.org/fpm/2003/0600/p27.html

Time Is on Your Side: Coding on the Basis of Time -- FPM

Dec 1, 2008 - E/M coding can be so complex that you forget those visits where it's just a matter of time.

Family Practice Management : Articles

https://www.aafp.org/fpm/2008/1100/p17.html

Time-Based Coding Guidelines

...15 99213 20 99202 25 99214 30 99203 40 99215 45 99204 60 99205 OUTPATIENT CONSULTATIONS, NEW OR ESTABLISHED Avg. minutes spent (face-to-face) Consultation code 15 99241 30 99242 40 99243 60 99244 80 99245 When physicians provide services...

Family Practice Management

https://www.aafp.org/fpm/2003/0600/fpm20030600p27-rt1.pdf

Transitional Care Management Services: New Codes, New Requirements -- FPM

Jun 1, 2013 - Two new codes will help you get paid for managing a patient’s transition from the inpatient to outpatient setting, but they come with new expectations.

Family Practice Management : Articles

https://www.aafp.org/fpm/2013/0500/p12.html

Treating Dementia With Shared Group Visits -- FPM

Jun 1, 2015 - Seeing patients with dementia in a group setting can streamline visits and help provide support for caregivers and families.

Family Practice Management : Articles

https://www.aafp.org/fpm/2015/0500/p16.html

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