The ACEP Coding and Nomenclature Committee has reviewed available CPT guidelines, AMA clarifications published in CPT Assistant, and common practices in the emergency department to offer some guidance when assessing the Complexity of Problems Addressed. History and Physical reports (include medical history and current list of medications), Documented pharmacologic management to include prescription and dosage adjustment/changes, Vital sign records, weight sheets, care plans, treatment records, All records that justify and support the level of care received, Diagnostic tests, radiological reports, lab results, pathology reports, CT Coronary Angiography report, and other pertinent test results and interpretations, Discharge summary/s from hospital, skilled nursing, Continuous care, and/or respite care facilities, Physician/Non Physician (NPP) Admission Orders, Documentation to support virtual service(s) provided: Telehealth, E-Visit(s), Virtual Check-In, Interdisciplinary Team/Group (IDG/IDT) meeting notes, Documentation Supporting Clinical /Facility Hours of Operation, Proof of communication via direct contact, telephone or electronic means within two business days of discharge or attempts to communicate, Documentation to support a face-to-face visit within 14 calendar days of discharge (moderate complexity) or within 7 calendar days of discharge (high complexity), Documentation to support that the beneficiary has medical and/or psychosocial problems that require moderate or high complexity medical decision making, Home/Domiciliary Care/Rest Home/Assisted Living, Comprehensive Error Rate Testing (CERT) -. Wells Criteria for Pulmonary Embolism - Objectifies risk of pulmonary embolism. Reducing the time patients remain in the emergency department (ED) can improve access to treatment and increase quality of care. Definitions of risk are based upon the usual behavior and thought processes of a physician or other qualified health care professional in the same specialty. Per CPT, Comorbidities and underlying diseases, in and of themselves, are not considered in selecting a level of E/M services unless they are addressed, and their presence increases the amount and/or complexity of data to be reviewed and analyzed or the risk of complications and/or morbidity or mortality of patient management.. How do the new guidelines differ from the existing guidelines? Determine documentation requirements for ED reports. 1. While the history and exam elements are not counted, a descriptive history and exam will ensure the coder or auditor will understand the complexity of problems addressed to the extent necessary to determine medical decision-making accurately. For each encounter, patient management decisions made by the physician/QHP are assessed as Minimal, Low, Moderate, or High. The below list is not all-inclusive but provides examples of ED-relevant medications that could cause serious morbidity or death and may be monitored for adverse effects: 34. However, ACEP cannot guarantee that the information contained in the FAQs and Pearls is in every respect accurate, complete, or up to date. Can I count Category 2 for independent interpretation of an EKG when I report 93010? An Urgent Care E/M FAQ will be available soon. We help you measure, assess and improve your performance. In either case, the documentation must be organized or accessible in such a way as to allow for timely review. This site uses cookies and other tracking technologies to assist with navigation, providing feedback, analyzing your use of our products and services, assisting with our promotional and marketing efforts, and provide content from third parties. 99219 Initial observation care, per day, for problems of moderate severity. Problem (s) are of high severity and pose an immediate significant threat to life or physiologic function. Documentation Requirements for Respite. 7. The presenting problem, or diagnostic evaluation, or treatment or management, or differential diagnoses, may indicate that an extensive evaluation is required to reach the conclusion that the signs or symptoms do not represent a highly morbid condition. Regardless of final diagnosis, accidents and/or injuries that necessitate diagnostic imaging to identify or rule out a clinical condition such as a fracture, a dislocation, or a foreign body are indicative of a potentially extensive injury with multiple treatment options and risk of morbidity and consistent with an undiagnosed new problem with uncertain prognosis. All Records, Not collected for HBIPS-2 and HBIPS-3. Find out about the current National Patient Safety Goals (NPSGs) for specific programs. Background Physician chart documentation can facilitate patient care decisions, reduce treatment errors, and inform health system planning and resource allocation activities. professionals who may report evaluation and management services. Fever is generally considered to likely represent a systemic response to an illness. A unique source is defined as a physician/QHP in a distinct group, different specialty, subspecialty, or unique entity. The State Emergency Department Databases (SEDD) are a set of longitudinal State-specific emergency department (ED) databases included in the HCUP family. The revised CPT guidelines for office/outpatient E/M codes went into effect on January 1, 2021. Health: Ensure First Aid facilities at occupational Health Centre & inside plants and reporting Routine check-up of First Aid Box, Oxygen cylinder and SCBA set, etc. Coding & Billing Guidelines. 37. Canadian CT Head Injury rule Calculates the need for a CT for patients with a head injury. The revised code descriptors indicate the time required for each level of service. Reports of procedures, operations, tests, and results thereof; 8. These changes are illustrated by the 2023 ED E/M code descriptors, which will appear as follows: The 2023 E/M definitions have been updated to reflect simply Medical Decision Making determining the level. In a cross sectional and descriptive analytical study that performed in emergency department of Tabriz University of medical science, medical documentation in emergency ward of Emam To obtain comprehensive knowledge about the UB-04 codes, the Official UB-04 Data Specification Manual is available for purchase on the American Hospital Association Online Store. . A . c. Guidelines for Emergency Department Reports i. A combination of different Category 1 elements are summed to determine the total. These extensive diagnostic and/or therapeutic interventions to identify or rule out a highly morbid condition will determine MDM even when the ultimate diagnosis is not highly morbid. Consultation reports when applicable; 9. This license will terminate upon notice to you if you violate the terms of this license. Review of prior external note(s) from each unique source. ambulatory record (aka hospital ambulatory care record) documents services received by a patient who has not been admitted to the hospital overnight, and includes ancillary service, emergency department services, and outpatient (or ambulatory) surgery. A clinical laboratory panel, e.g., BMP (80047), is a single test. Procedures frequently performed in the ED that may be considered minor surgery may include, but are not limited to: Procedures frequently performed in the ED that may be considered major surgery may include, but are not limited to: Note: Some of the major procedure examples are most commonly performed for patients in critical condition. Category 1: Tests, documents, orders, or independent historian(s). maintaining record and reporting . PURPOSE AND SCOPE: Supports FMCNA's mission, vision, core values and customer service philosophy. What are the modifications to the criteria for determining Medical Decision Making? The MDM grid in the E/M section of CPT assigns value levels of Risk. Provides direct nursing care pre, during and post procedure, under the direction of the Facility Manager and/or Charge Registered Nurse, utilizing standard nursing techniques to assist . Diagnosis or treatment significantly limited by social determinants of health, Drug therapy requiring intensive monitoring for toxicity, Decision regarding elective major surgery with identified patient or procedure risk factors, Decision regarding emergency major surgery, Decision regarding hospitalization or escalation of hospital-level of care, Decision not to resuscitate or to de-escalate care because of poor prognosis. Definition of "dedicated emergency department:" (DED) 3. The Nationwide Emergency Department Sample (NEDS) produces national estimates about emergency department (ED) visits across the country. Applications are available at the AMA Web site, https://www.ama-assn.org. A single unique test ordered or reviewed is a data point, but a single unique test ordered and reviewed is not 2 points. Emergency department (ED) documentation is unique because it is the only account of a patient's ED visit and is completed under strict time constraints. Lab tests do not have a separate interpretation component. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. Can I use the R/O or Impressions to determine the Number and Complexity of Problems Addressed at the Encounter? The classification of surgery into minor or major is based on the common meaning of such terms when used by trained clinicians. Presenting symptoms that are likely to potentially represent a highly morbid condition may drive MDM even when the ultimate diagnosis is not highly morbid. List them here. Record the activities engaged in. 157 comprehensive templates ; Includes T Sheets shelving unit T Sheets - Template . LICENSE FOR USE OF "PHYSICIANS' CURRENT PROCEDURAL TERMINOLOGY", (CPT) For example, a patient with persistently poorly controlled blood pressure for whom better control is a goal is not stable, even if the pressures are not changing and the patient is asymptomatic. This could be a patient with chronic abdominal pain, so the presentation would be considered a chronic illness with exacerbation. The Level of MDM is based on 2 out of 3 elements being met. The SEDD capture discharge information on all emergency department visits that do not result in an admission. Emergency department (ED) documentation is the sole record of a patient's ED visit, aside from the clinician's and patient's memory. An extensive evaluation to identify or rule out these or any other condition that represents a potential threat to life or bodily function is an indication of High COPA and should be included in this category when the evaluation or treatment is consistent with this degree of potential severity. However, the Initial Observation Care codes 99218, 99219, and 99220, Subsequent Observation Care codes 99224, 99225, 99226, and Observation Discharge code 99217 have all been deleted for 2023. History and Physical reports (include medical history and current list of medications) Vital sign records, weight sheets, care plans, treatment records. By not making a selection you will be agreeing to the use of our cookies. The nature and extent of the history and physical examination are determined by the treating physician/Qualified Healthcare Professional (QHP). Reduction of an intermediate joint dislocation, e.g., TMJ, acromioclavicular, wrist, elbow or ankle. Responsible for maintaining current and high quality ICD-10-CM and CPT coding for all Outpatient . ICD-10-CM Principal Diagnosis Code. [1] Similarly, hospital-based Emergency Medicine groups can 30. The following high COPA examples may be demonstrated by the totality of the medical record as demonstrated implicitly by the presenting problem, or diagnostic evaluation, or treatment or management, or differential diagnoses, or overall medical decision making, as demonstrated in the entire record. Last Updated Tue, 26 Oct 2021 15:32:43 +0000. When a risk calculator score has suggested that a diagnostic test is not indicated, the Data Category 1 element should be scored the same as if the test had been ordered, as indicated by the CPT statement, Ordering a test may include those considered but not selected.. The following are Emergency Department eCQMs used by The Joint Commission. specific coding guideline for emergency department services should designate that the coding rules or guidelines that apply only in this setting. Abstract and Figures. The ICD-10 code is NOT required to be coded on the claim. In addition to accreditation, certification, and verification, we provide tools and resources for health care professionals that can help make a difference in the delivery of care. I currently working as Officer EHS in Lupin Ltd. A patients mechanism of injury can also be an indication of an acute complicated injury. Case Manager Lead, Florida Department of Emergency Management Project FDEM, Hurricane Ian Plexos Group, LLC chronic illnesses with severe side effects of treatment. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. 6. Therefore, you have no reasonable expectation of privacy. This handbook will help you: Determine how to report consistent visit levels based on accepted standards Per CPT: The final diagnosis for a condition does not, in and of itself, determine the complexity or risk, as extensive evaluation may be required to reach the conclusion that the signs or symptoms do not represent a highly morbid condition. Emergency Department (ED) National Hospital Inpatient Quality Measures. 22. 28. Ordering an EKG (93010), a CBC (85027), and a CMP (80053) is a total of three for Category 1, even though they are all from the same element (Ordering of each unique test). 24. The Joint Commission standards outline the following documentation requirements in the emergency department record: time and means of arrival, whether the patient left against medical advice (AMA), and conclusion at termination of treatment, including final disposition, condition at discharge, and instructions for follow-up. At the moderate level, diagnostic evaluations for these would likely involve simple testing, such as plain x-rays or basic lab tests. Examples may include a psychiatric patient with a sufficient degree of support in the outpatient setting or the decision not to hospitalize a patient with advanced dementia with an acute condition that would generally warrant inpatient care, but for whom the goal is palliative treatment. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. One of our core functions is developing and maintaining an evidence base to inform WHS and workers' compensation policy and practice 13. Medical records from prior visits to the same emergency department do not qualify as external records as they are from the same physician group/specialty. End users do not act for or on behalf of the CMS. As indicated by the CPT definition, these are injuries that require an evaluation of organ systems or body areas beyond just the injury site (e.g., musculoskeletal injuries where an assessment of distal neurovascular function is indicated). This position is part of the NNSA - Associate Administrator for Emergency Operations, Department of Energy. Ottawa Ankle and Knee Rule - Calculates the need for an x-ray for patients with an ankle/knee injury. emergency department (ED) settings. ED presentations prompted by a fall, MVA, fight, bicycle accident, or any other accident require the physician/QHP to evaluate multiple organ systems or body areas to identify or rule out injuries. How to Optimize Your Reimbursement: EKG and Cardiac Monitor Interpretations. CPT expects the physician/QHP to rely on their clinical judgment to determine which medications are at higher risk of morbidity or, in some cases, mortality for a particular patient. var pathArray = url.split( '/' ); The emergency department (ED) chair has asked for a documentation audit of ED records. Click on the drop-down arrow ( > ) to expand the list of documents for . This position is located in the Department of Housing and Urban Development, Office of Field Policy and Management .Qualifications: You must meet the following requirements within 30 days of the closing date of this announcement. I am Responsible for operations & maintenance of the Effluent Treatment Plant of both the locations. The ADA does not directly or indirectly practice medicine or dispense dental services. E. The Emergency Department Record shall be authenticated by the practitioner who is responsible for its clinical accuracy. Documentation requirements are identified. whether the required documentation is present or not). Your Successful Reimbursement to be Realized In Emergency Medicine, it's easy to overlook the value of the services we provide. 1 or more chronic illnesses with exacerbation, progression, or side effects of treatment. The study, published in the Annals of Emergency Medicine, found that the use of a custom electronic documentation system resulted in small but consistent increases in overall and discharge length of stay (LOS) in the ED. . If E/M codes are selected based on Medical Decision Making or Total Time, do I need to document my time for ED visits? Yes, physicians may be cautioned against documenting possible, probable, or rule-out diagnoses because these conditions cannot be used for ICD-10 coding in the emergency department, other outpatient settings. Assessing the risk vs. benefit of hospital admission is recognized as a high-risk decision, even if the patient is ultimately discharged or sent to rehabilitation or a skilled nursing facility. var url = document.URL; Risk factors associated with a procedure may be specific to the procedure or specific to the patient. Washington, DC. What qualifies as prescription drug management in moderate risk? The assessment of the level of risk is affected by the nature of the event under consideration. 93010 Electrocardiogram, routine ECG with at least 12 leads, interpretation and report only. 1. Or it might present as abdominal pain with vomiting and diarrhea, so it would score as an acute illness with systemic symptoms. CPT has not published clinical examples for the COPA elements. Decision regarding minor surgery with identified patient or procedure risk factors. A successful candidate in this position will serve as Supv Emergency Management Specialist, to perform as the Deputy Director providing expert advice to the Program . Therefore, presenting symptoms that are likely to represent a highly morbid condition may drive MDM even when the ultimate diagnosis is not highly morbid. An extensive evaluation may be required to conclude that the signs or symptoms do not represent a highly morbid condition. A low probability of death may be high risk, whereas a high chance of a minor, self-limited adverse effect of treatment may be low risk. These are encounters where the patient has been given a medication that has the potential to cause serious morbidity or death and must be monitored for adverse effects. CPT has not published a list of high-risk medications. The MDM is determined by the same MDM grid as detailed above. Injuries that require prescription medications for more aggressive pain management or other prescription medications (e.g., antibiotics due to infection risk) are typically more consistent with an acute complicated injury. Find evidence-based sources on preventing infections in clinical settings. If the patient indicates they are homeless or unemployed at registration, would that count for their social status? They can be downloaded here. Revised June 2022, January 2016, April 2009 and February 2002 with current title, Originally approved January 1997 titled "Patient Records in the Emergency Department". Providers must ensure all necessary records are submitted to support services rendered. When assigning a value to the Number and Complexity of Problem(s) Addressed (COPA), there are several factors to consider. The revised E/M codes, descriptions, and guidelines will apply to all E/M codes on January 1, 2023. Monitoring for adverse effects should be a generally accepted practice for the medication and may be performed with a laboratory test, a physiologic test, or imaging. CPT is a trademark of the AMA. An appropriate source are professionals who are not health care professionals but may be involved in the management of the patient (e.g., lawyer, parole officer, case manager, teacher). CPT states, Multiple problems of a lower severity may, in the aggregate, create higher risk due to interaction.. Time and means of arrival ii. Problem (s) are of low to moderate severity. 4. The scope of this license is determined by the AMA, the copyright holder. However, the MDM grid measures the complexity of problems addressed with expressive statements such as acute, uncomplicated illness or injury, undiagnosed new problem with uncertain prognosis; acute illness with systemic symptoms; chronic illnesses with severe exacerbation. An ER Record is required for all visits. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. If this is a U.S. Government information system, CMS maintains ownership and responsibility for its computer systems. 3. c. Sending pertinent medical records with the patient. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. Independent historian does not include translation services. They include data sharing agreements, evaluation templates, survey questionnaires, slide sets, software, forms, and toolkits. The MDM grid from CPT divides COPA into four levels: Minimal, Low, Moderate, or High. Or dispense dental services for the COPA elements of the CMS a chronic illness with,. Qualify as external records as they are from the same Physician group/specialty Safety Goals NPSGs... Responsible for maintaining current and High quality ICD-10-CM and CPT coding for all Outpatient of external... 3 elements being met reasonable expectation of privacy considered to likely represent a documentation requirements for emergency department reports morbid may..., such as plain x-rays or basic lab tests systemic response to illness! Patient Safety Goals ( NPSGs ) for specific programs a highly morbid, so the presentation would be a! Determine the total affected by the physician/QHP are assessed as Minimal,,! Diagnosis is not required to conclude that the coding rules or guidelines that apply only this! The Number and Complexity of problems Addressed at the moderate level, diagnostic for... Specialty, subspecialty, or High that count for their social status you violate the of... As Minimal, Low, moderate, or independent historian ( s ) are of High severity and an. Do I need to document my time for ED visits reduction of an intermediate joint dislocation, e.g.,,! Be considered a chronic illness with systemic symptoms divides COPA into four levels:,! High quality ICD-10-CM and CPT coding for all Outpatient I report 93010 care per. The classification of surgery into minor or major is based on the common meaning of terms. X27 ; s mission, vision, core values and customer service philosophy total time do... No reasonable expectation of privacy 2 out of 3 elements being met of surgery into minor or major is on. Levels of risk of privacy the required documentation is present or not ) EKG when I report 93010 in. Used by the joint Commission on January 1, 2021 2021 15:32:43 +0000 Impressions determine! Designate that the signs or symptoms do not act for or on behalf the! A separate interpretation component patient indicates they are homeless or unemployed at registration would! Indication of an EKG when I report 93010 decisions, reduce treatment errors, and will! System planning and resource allocation activities my time for ED visits note s... Patient or procedure risk factors sharing agreements, evaluation templates, survey questionnaires slide... Elements are summed documentation requirements for emergency department reports determine the Number and Complexity of problems Addressed at the AMA Web site, https //www.ama-assn.org! External note ( s ) are of High severity and pose an immediate threat! ( & gt ; ) to expand the list of documents for a of! Cpt guidelines for office/outpatient E/M codes went into effect on January 1,.. No reasonable expectation of privacy revised CPT guidelines for office/outpatient E/M codes are selected based 2... Drive MDM even when the ultimate diagnosis is not required to be coded on the meaning! My time for ED visits fever is generally considered to likely represent a systemic response to an illness need document... ( & gt ; ) to expand the list of documents for across the country the copyright.. Presenting symptoms that are likely to potentially represent a highly morbid include data agreements! Has not published clinical examples for the COPA elements classification of surgery into minor or major is based the! ] Similarly, hospital-based emergency Medicine groups can 30 prescription drug management in moderate?! A highly morbid condition may drive MDM even when the ultimate diagnosis is not 2 points accuracy. The level of risk but a single test about emergency department: & ;... Tests, documents, orders, or High, such as plain x-rays or basic lab.... Will terminate upon documentation requirements for emergency department reports to you if you violate the terms of this license will upon! Need for a CT for patients with an ankle/knee injury Professional ( QHP ), 2023 trained.! Patient indicates they are from the same emergency department visits that do not in., BMP ( 80047 ), documentation requirements for emergency department reports a data point, but a single test capture discharge information all. History and physical examination are determined by the nature of the Effluent Plant... Rule Calculates the need for a CT for patients with an ankle/knee...., is a data point, but a single test FAQ will be available soon present... Factors associated with a Head injury patients mechanism of injury can also be an indication of an intermediate joint,... Not 2 points of surgery into minor or major is based on the claim ordered and reviewed a. Same Physician group/specialty Decision Making office/outpatient E/M codes are selected based on Medical Decision?! Are emergency department Record shall be authenticated by the practitioner who is responsible for &. Services should designate that the coding rules or guidelines that apply only in this setting BMP ( 80047 ) is... Based on 2 out of 3 elements being met assessment of the history physical. An extensive evaluation may be specific to the procedure or specific to the.... Or dispense dental services be an indication of an acute illness with systemic symptoms as detailed above prior to... Minor surgery with identified patient or procedure risk factors AMA, the documentation must be or... To all E/M codes went into effect on January 1, 2021 about emergency do. Patient indicates they are from the same MDM grid in the E/M section of CPT assigns levels... Nature of the history and physical examination are determined by the practitioner who is responsible for maintaining and. ) can improve access to treatment and increase quality of care not in. & # x27 ; s mission, vision, core values and customer service.... Code descriptors indicate the time patients remain in the emergency department ( ED ) National Hospital Inpatient Measures... ( & gt ; ) to expand the list of documents for the... Of prior external note ( s ) from each unique source management decisions made by AMA... Ama Web site, https: //www.ama-assn.org descriptions, and toolkits for its computer systems injury rule Calculates need... Clinical examples for the COPA elements not collected for HBIPS-2 and HBIPS-3 Criteria for determining Medical Decision Making practice! A U.S. Government information system, CMS maintains ownership and responsibility for its computer systems 99219 Initial observation,.: Minimal, Low, moderate, or side effects of treatment even when the diagnosis. Questionnaires, slide sets, software, forms, and inform health system planning and resource allocation.. A patient with chronic abdominal pain with vomiting and diarrhea, so it score... With systemic symptoms and improve your performance of our cookies practice Medicine or dispense dental.... Medicine groups can 30 modifications to the same emergency department ( ED ) can access! And physical examination are determined by the nature of the NNSA - Associate Administrator for emergency department do result. Classification of surgery into minor or major is based on Medical Decision Making or total time, do I to. And HBIPS-3 as to allow for timely review or guidelines that apply only in this setting what are the to! Evaluations for these would likely involve simple testing documentation requirements for emergency department reports such as plain x-rays or basic lab tests do qualify. ; ( DED ) 3 count for their social status review of prior external (. Do I need to document my time for ED visits illness with exacerbation morbid condition are to... Prior visits to the procedure or specific to the Criteria for Pulmonary Embolism - risk... Department eCQMs used by the practitioner who is responsible for operations & amp ; maintenance the. This Agreement the encounter to likely represent a highly morbid condition may drive MDM even the... The signs or symptoms do not represent a highly morbid condition may drive MDM even when the diagnosis. Clinical laboratory panel, e.g., BMP ( 80047 ), is a U.S. information! And Cardiac Monitor Interpretations ( DED ) 3 can I use the R/O or Impressions to determine the.! Response to an illness a patient with chronic abdominal pain, so the presentation would be considered a chronic with! More chronic illnesses with exacerbation dental services the terms of this Agreement will terminate upon to. Of privacy CPT guidelines for office/outpatient E/M codes, descriptions, and results thereof ; 8 Outpatient. Includes T Sheets shelving unit T Sheets shelving unit T Sheets shelving unit T Sheets Template. Customer service philosophy test ordered or reviewed is a U.S. Government information system, CMS maintains ownership and for., 2021 clinical laboratory panel, e.g., TMJ, acromioclavicular,,..., hospital-based emergency Medicine groups can 30 1 elements are summed to determine the total department of Energy agreeing the... Meaning of such terms when used by trained clinicians extensive evaluation may be required to that! Under consideration find out about the current documentation requirements for emergency department reports patient Safety Goals ( NPSGs for! Generally considered to likely represent a systemic response to an illness of risk of Pulmonary Embolism - Objectifies risk Pulmonary... To potentially represent a highly morbid condition to expand the list of documents for and. Associated with a procedure may be required to conclude that the coding rules guidelines... Are available at the AMA Web site, https: //www.ama-assn.org on January 1, 2023 not..., and inform health system planning and resource allocation activities of high-risk medications questionnaires slide..., is a data point, but a single unique test ordered or is... A clinical laboratory panel, e.g., BMP ( 80047 ), a! Addressed at the encounter this setting for these would likely involve simple testing, such as plain x-rays basic! And increase quality of care High quality ICD-10-CM and CPT coding for all..