1. What are the icons used for?
The icons are clickable informational links to assist you with understanding the term used in the score sheet.
2. Is the beneficiary name field required?
This field is not required to use the score sheet. It was added to allow the user to enter patient name, or any other patient specific identifying information for printing and/or filing purposes only. Novitas does not use nor retain the data entered in this field.
3. How does the score sheet know which set of guidelines to score based on for office/outpatient visits?
The score sheet is date of service driven to ensure the user scores based on the correct guidelines. If the date of service is in 2021, the score sheet will ask, “Is this related to an office or outpatient services visit”. If yes is selected, the system will display the scoring elements based on the 2021 guidelines.
4. Does the score sheet also score prolonged services when time is entered beyond the highest level new and established patient visit?
No, the score sheet will only provide a suggested code for the E/M level of service. A note will populate alerting you the service may qualify for additional prolonged services with a link to the prolonged service information.
5. Is total time required to be entered when determining the level of service?
The office/outpatient scoring for 2021 allows you to enter the total time or start and end times. If using start and end times, the score sheet will calculate the total time.
6. My documentation includes multiple start and stop times throughout the note. Can I enter each time block in the score sheet?
Yes, the score sheet allows for multiple start and end times to be entered. The score sheet will calculate the total time. Be sure to click “add” to enter multiple start and end times. You may also delete a line is keyed incorrectly.
7. If scoring based on time, is it also required to score the medical decision making?
It is suggested to score both the time and medical decision making to allow billing of the highest scoring component. The score sheet will display the suggested E/M code in each section based on the data entered.
8. How do I score the medical decision making section?
9. When scoring the amount and/or complexity of data to be reviewed and analyzed section, how are each unique source* and each unique test* in Category 1 counted?
The AMA – CPT E/M Office Revisions – Level of medical decision making table
indicates *Each unique test, order, or document contributes to the combination of 2 or combination of 3 in Category 1. For example, if a physician orders a complete blood count, basic metabolic panel and lipid panel , this counts as 3 unique tests. This would satisfy category 1 of a moderate level of amount and/or complexity of data to be reviewed and analyzed.