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E/M Patient Criteria

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1. E/M Patient Criteria

E/M Patient Criteria E/M Patient Criteria Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 E/M Patient Criteria E/M Patient Criteria (...) Aka: E/M Patient Criteria , E/M New Patient , E/M Established Patient II. Patient Type: New Description: New to group specialty within 3 years No physician from same specialty in the same group No professional services in the last 3 years Related E/M Codes for outpatient services III. Patient Type: Established Description: Care from group specialty within 3 years Physician from same specialty in the same group Professional services in the last 3 years Includes call coverage Related E/M Codes

2018 FP Notebook

2. E/M Examination Criteria

E/M Examination Criteria E/M Examination Criteria Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 E/M Examination Criteria E/M (...) Examination Criteria Aka: E/M Examination Criteria , E/M Problem Focused Exam , E/M Expanded Problem Focused Exam , E/M Detailed Exam , E/M Comprehensive Exam II. Exam: Vital Signs (3 of 8 are required to count as one exam component) (sitting or standing) (supine) Height Weight III. Exam: Systems (12) s Constitutional Eyes Ears, Nose, Throat Cardiovascular Respiratory Gastrointestinal Genitourinary Musculoskeletal Skin (integument, includes s) Neurologic Psychiatric Hematologic or Lymphatic IV. Type

2018 FP Notebook

3. E/M History Criteria

E/M History Criteria E/M History Criteria Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 E/M History Criteria E/M History Criteria (...) Aka: E/M History Criteria , E/M Problem Focused History , E/M Expanded Problem Focused History , E/M Detailed History , E/M Comprehensive History II. Approach See History of Present Illness (HPI): 8 Components (Must be asked by provider) Location Severity Timing Modifying factors Quality Duration Context Associated signs and symptoms Past Medical, and Social History (PFSH) - may be obtained by form, scribe, CMA or other staff Past Medical History Social History (ROS): 14 components (may

2018 FP Notebook

4. Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease

A. Guyton, MD, FACC Mark A. Hlatky, MD, FACC Harold L. Lazar, MD, FACC Vera H. Rigolin, MD, FACC Geoffrey A. Rose, MD, FACC, FASE Richard J. Shemin, MD, FACC Jacqueline E. Tamis-Holland, MD, FACC Carl L. Tommaso, MD, FACC, FSCAI L. Samuel Wann, MD, MACC John B. Wong, MD Appropriate Use Criteria Task Force John U. Doherty, MD, FACC, Co-Chair Gregory J. Dehmer, MD, MACC, Co-Chair Steven R. Bailey, MD, FACC, FSCAI, FAHA Nicole M. Bhave, MD, FACC Alan S. Brown, MD, FACC Stacie L. Daugherty, MD, FACC Milind (...) Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease | JACC: Journal of the American College of Cardiology Advertisement User menu Source Search for this keyword Search Source Search for this keyword Search Journal of the American College of Cardiology DOI: 10.1016/j.jacc.2017.02.001 ACC/AATS/AHA/ASE

2017 Society for Cardiovascular Angiography and Interventions

5. Appropriate Use Criteria: Imaging of the Brain

criteria for medical necessity determinations where possible. In the process, multiple functions are accomplished: ? To establish criteria for when services are medically necessary ? To assist the practitioner as an educational tool ? To encourage standardization of medical practice patterns ? To curtail the performance of inappropriate and/or duplicate services ? To advocate for patient safety concerns ? To enhance the quality of health care ? To promote the most efficient and cost-effective use (...) circumstances and the local delivery system into account when determining the medical appropriateness of health care services. The AIM Guidelines are just guidelines for the provision of specialty health services. These criteria are designed to guide both providers and reviewers to the most appropriate services based on a patient’s unique circumstances. In all cases, clinical judgment consistent with the standards of good medical practice should be used when applying the Guidelines. Guideline determinations

2019 AIM Specialty Health

6. Appropriate Use Criteria: Imaging of the Abdomen and Pelvis

where possible. In the process, multiple functions are accomplished: ? To establish criteria for when services are medically necessary ? To assist the practitioner as an educational tool ? To encourage standardization of medical practice patterns ? To curtail the performance of inappropriate and/or duplicate services ? To advocate for patient safety concerns ? To enhance the quality of health care ? To promote the most efficient and cost-effective use of services The AIM guideline development (...) into account when determining the medical appropriateness of health care services. The AIM Guidelines are just guidelines for the provision of specialty health services. These criteria are designed to guide both providers and reviewers to the most appropriate services based on a patient’s unique circumstances. In all cases, clinical judgment consistent with the standards of good medical practice should be used when applying the Guidelines. Guideline determinations are made based on the information provided

2019 AIM Specialty Health

7. E/M Nature of Presenting Problem

of Presenting Problem E/M Nature of Presenting Problem Aka: E/M Nature of Presenting Problem , E/M Minimal Problem , E/M Self Limited or Minor Problem , E/M Low Severity Problem , E/M Moderate Severity Problem , E/M High Severity Problem II. Nature of Problem: Minimal Criteria Problem does not require physician presence Service provided under supervision of a physician Related Codes E/M Established Outpatient: III. Nature of Problem: Self limited or Minor Criteria Minimal number of diagnoses or management (...) , mortality Related Codes VI. Nature of Problem: High Severity Criteria Extensive diagnoses or management options Extensive amount or complexity of data to be reviewed High risk of complications, morbidity, mortality Related Codes Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "E/M Nature of Presenting Problem." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database

2018 FP Notebook

8. E/M Medical Decision Making

/M Medical Decision Making Aka: E/M Medical Decision Making , E/M Straightforward Medical Decision , E/M Low Complexity Medical Decision , E/M Moderate Complexity Medical Decision , E/M High Complexity Medical Decision II. Decision Making Type: Straightforward Criteria Minimal number of diagnoses or management options Minimal or no data to be reviewed Minimal risk of complications, morbidity, mortality Related Codes III. Decision Making Type: Low Complexity Criteria Limited number of diagnoses (...) E/M Medical Decision Making E/M Medical Decision Making Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 E/M Medical Decision Making E

2018 FP Notebook

9. Evidence Brief: Use of Performance Measures as Criteria for Selecting Community Cardiac and Orthopedic Surgical Providers for the Veterans Choice Program

a national dissemination strategy for all ESP products; and interfaces with stakeholders to effectively engage the program. Comments on this evidence report are welcome and can be sent to Nicole Floyd, ESP CC Program Manager, at Nicole.Floyd@va.gov. Recommended citation: Peterson K, Anderson J, Bourne D, Boundy E, Helfand M. Evidence Brief: Use of Performance Measures as Criteria for Selecting Community Cardiac and Orthopedic Surgical Providers for the Veterans Choice Program. VA ESP Project #09-199 (...) Evidence Brief: Use of Performance Measures as Criteria for Selecting Community Cardiac and Orthopedic Surgical Providers for the Veterans Choice Program 4 4 Department of Veterans Affairs Health Services Research & Development Service Evidence-based Synthesis Program Evidence Brief: Use of Performance Measures as Criteria for Selecting Community Cardiac and Orthopedic Surgical Providers for the Veterans Choice Program June 2017 Prepared for: Department of Veterans Affairs Veterans Health

2017 Veterans Affairs Evidence-based Synthesis Program Reports

10. Comparative immuno-virological and clinical responses to antiretroviral therapy between HIV-1 group O- and HIV-1 group M-infected patients (ANRS 12168 DynaMO study). (PubMed)

-1/M patients were included. Mean pVL at baseline was significantly lower by 1 log for HIV-1/O versus HIV-1/M patients. At W48, no significant difference was observed between populations with undetectable pVL in 80.9% of HIV-1/O versus 75.5% of HIV-1/M patients. Differences at W24 and W96 were not significant. A difference in CD4 gain was observed in favor of HIV-1/M at W48 and W96, but this was not significant when adjusted on both matched criteria and pVL at baseline.Our data demonstrate (...) similar immuno-virological and clinical response between HIV-1/O and HIV-1/M patients, suggesting that genetic divergence does not impact therapeutic outcomes. They also reveal significantly lower baseline replication for HIV-1/O variants, suggesting specific virological properties and physiopathology that now need to be addressed.NCT00658346.© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail

2019 Clinical Infectious Diseases

11. Appropriate Use Criteria: Positron Emission Testing, Other PET Applications, including Oncologic Tumor Imaging

PET/CT findings with histopathological results in differentiated thyroid cancer patients who have increased thyroglobulin or antithyroglobulin antibody levels and negative 131I whole- body scan results. Clin Nucl Med. 2013;38(5):326-331. 38. Ozkan E, Soydal C, Araz M, Aras G, Ibis E. The additive clinical value of 18F-FDG PET/CT in defining the recurrence of disease in patients with differentiated thyroid cancer who have isolated increased antithyroglobulin antibody levels. Clin Nucl Med. 2012;37 (...) . These criteria are designed to guide both providers and reviewers to the most appropriate services based on a patient’s unique circumstances. In all cases, clinical judgment consistent with the standards of good medical practice should be used when applying the Guidelines. Guideline determinations are made based on the information provided at the time of the request. It is expected that medical necessity decisions may change as new information is provided or based on unique aspects of the patient’s condition

2018 AIM Specialty Health

12. Appropriate Use Criteria: Imaging of the Spine

for the provision of specialty health services. These criteria are designed to guide both providers and reviewers to the most appropriate services based on a patient’s unique circumstances. In all cases, clinical judgment consistent with the standards of good medical practice should be used when applying the Guidelines. Guideline determinations are made based on the information provided at the time of the request. It is expected that medical necessity decisions may change as new information is provided or based (...) conditions which predispose to instability at the craniocervical junction. Diagnosis of the etiology of neck pain in patients who are willing and able to undergo spine surgery or epidural steroid injection (ESI) when both of the following criteria are met: ? Lack of improvement or worsening during a six (6) week course of therapy with at least two (2) different forms of treatment ? Cervical spine X-ray is negative or does not clearly explain the cause of the patient’s symptoms. Neck pain

2018 AIM Specialty Health

13. Appropriate Use Criteria: Imaging of the Head & Neck

, Tijssen CC. Prediction of intracranial metastases in cancer patients with headache. Cancer. 2002;94(7):2063-2068. 20. Cianfoni A, Pravatà E, De Blasi R, Tschuor CS, Bonaldi G. Clinical presentation of cerebral aneurysms. Eur J Neurol. 2013;82(10):1618-1622. 21. Cueva RA. Clinical thresholds for when to test for retrocochlear lesions: pro. Arch Otolaryngol Head Neck Surg. 2010 Jul;136(7):725-7. 22. Cumurciuc R, Crassard I, Sarov M, Valade D, Bousser MG. Headache as the only neurological sign (...) a, McCrory DC, Booth CM. Does this patient with headache have a migraine or need neuroimaging? JAMA. 2006;296(10):1274-1283. 31. Devenney E, Neale H, Forbes RB. A systematic review of causes of sudden and severe headache (Thunderclap Headache): should lists be evidence based? J Headache Pain. 2014;15(1):49. 32. Donington J, Ferguson M,Thoracic Oncology Network of American College of Chest Physicians; Workforce on Evidence-Based Surgery of Society of Thoracic Surgeons, et al. American College of Chest

2018 AIM Specialty Health

14. Appropriate Use Criteria: Imaging of the Chest

diseases. Radiographics. 2005;25(1):157-173. 77. Tunick PA, Krinsky GA, Lee VS, Kronzon I. Diagnostic imaging of thoracic aortic atherosclerosis. AJR Am J Roentgenol. 2000;174(4):1119-1125. 78. Tüzün E, Dalmau J. Limbic encephalitis and variants: classification, diagnosis and treatment. Neurologist. 2007;13(5):261-271. 79. Uresandi F, Monreal M, Garcia-Bragado F, et al. National Consensus on the Diagnosis, Risk Stratification and Treatment of Patients with Pulmonary Embolism. Spanish Society (...) pulmonary origin. J Thorac Imaging. 2013;28(5):W64-W66. 22. Fabia Valls MJ, van der Hulle T, den Exter PL, et al. Performance of a diagnostic algorithm based on a prediction rule, D-dimer and CT-scan for pulmonary embolism in patients with previous venous thromboembolism. A systematic review and meta-analysis. Thromb Haemost. 2015;113(2):406-13. 23. Fasola G, Belvedere O, Aita M, et al. Low-dose computed tomography screening for lung cancer and pleural mesothelioma in an asbestos-exposed population

2018 AIM Specialty Health

15. Appropriate Use Criteria: Imaging of the Abdomen & Pelvis

Committee. J Am Coll Radiol. 2010;7(10):754-773. 11. Brancatelli G, Federle MP, Grazioli L, et al. Focal nodular hyperplasia: CT findings with emphasis on multiphasic helical CT in 78 patients. Radiology. 2001;219(1):61-68. 12. Caturelli E, Pompili M, Bartolucci F, Siena DA, Sperandeo M, Andriulli A, Bisceglia M. Hemangioma-like lesions in chronic liver disease: diagnostic evaluation in patients. Radiology. 2001 Aug;220(2):337-342. 13. Chou R, Cuevas C, Fu R, et al. Imaging Techniques for the Diagnosis (...) . 2013;19(1):3-26. 36. Mandeville JA, Gnessin E, Lingeman JE. Imaging evaluation in the patient with renal stone disease. Semin Nephrol. 2011 May;31(3):254-258. 37. Marrero JA, Ahn J, Rajender Reddy K. American College of Gastroenterology clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol. 2014;109(9):1328-1347. 38. Matsuki M, Kani H, Tatsugami F, et al. Preoperative assessment of vascular anatomy around the stomach by 3D imaging using MDCT before laparoscopy

2018 AIM Specialty Health

16. Required hospital capacity in 2025 and criteria for rationalisation of complex cancer surgery, radiotherapy and maternity services

, Grau C, Jeurissen P, Kruse FM, Lefèvre M, Lievens Y, Mistiaen P, Vaandering A, Van Eycken E, van Ginneken E. Required hospital capacity in 2025 and criteria for rationalisation of complex cancer surgery, radiotherapy and maternity services. Health Services Research (HSR) Brussels: Belgian Health Care Knowledge Centre (KCE). 2017. KCE Reports 289. D/2017/10.273/45. This document is available on the website of the Belgian Health Care Knowledge Centre. KCE Report 289 Required hospital capacity (...) ON EPIDEMIOLOGICAL DATA 150 2.3.1 Incidence/prevalence of dementia 150 2.3.2 Hospital use by dementia patients 154 2.4 RESULTS ON INTERVENTIONS TO REDUCE HOSPITAL USE BY DEMENTIA PATIENTS 162 2.4.1 Strategies outside the hospital with an impact on hospital use 162 2.4.2 Strategies in the hospital 164 2.4.3 Strategies with regard to fall prevention 166 2.5 DISCUSSION AND CONCLUSION 166 3 ENGLAND 169 3.1 BACKGROUND 169 KCE Report 289 Required hospital capacity and criteria for rationalisation 3 3.1.1 Country

2017 Belgian Health Care Knowledge Centre

17. Use of Performance Measures as Criteria for Selecting Community Surgical Providers

measures, such as presence of pre-discharge assessment and ensuring every patient is scheduled for a follow-up visit. Further, to improve capabilities to monitor Veterans' outcomes in the community and to compare to care within VA, Secretary Shulkin and others have called for the creation of data standards and standardized electronic data systems that would better permit aggregation of data across sites. Reference Peterson K, Anderson J, Bourne D, Boundy E, Helfand M. Evidence Brief: Use of Performance (...) Use of Performance Measures as Criteria for Selecting Community Surgical Providers Management Briefs eBrief-no130 -- Enter search terms Button to search HSRD ® Inside VA Budget and Performance Inside the News Room National Observances Special Events » » » » » Management Briefs eBrief-no130 -- Health Services Research & Development Management eBrief no. 130 » Issue 130 September 2017 The report is a product of the VA/HSR&D Evidence Synthesis Program. Evidence Brief: Use of Performance Measures

2017 Veterans Affairs - R&D

18. 2017 SCAI Appropriate Use Criteria for Peripheral Arterial Interventions

2017 SCAI Appropriate Use Criteria for Peripheral Arterial Interventions SCAI appropriate use criteria for peripheral arterial interventions: An update - Klein - 2017 - Catheterization and Cardiovascular Interventions - Wiley Online Library Search within Search term Search term The full text of this article hosted at iucr.org is unavailable due to technical difficulties. Peripheral Vascular Disease (E‐only Article) Free Access SCAI appropriate use criteria for peripheral arterial interventions (...) . Current appropriate use criteria support endovascular intervention for asymptomatic aorto‐iliac arterial disease to allow vascular access for life‐saving devices (e.g., mechanical circulatory support, or TAVR). This can be accomplished with primary or provisional stent placement . Internal iliac artery intervention is effective in patients with lifestyle limiting buttock or hip claudication due to stenotic disease. Internal iliac revascularization may be appropriate when there is a significant

2017 Society for Cardiovascular Angiography and Interventions

19. E/M Patient Criteria

E/M Patient Criteria E/M Patient Criteria Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 E/M Patient Criteria E/M Patient Criteria (...) Aka: E/M Patient Criteria , E/M New Patient , E/M Established Patient II. Patient Type: New Description: New to group specialty within 3 years No physician from same specialty in the same group No professional services in the last 3 years Related E/M Codes for outpatient services III. Patient Type: Established Description: Care from group specialty within 3 years Physician from same specialty in the same group Professional services in the last 3 years Includes call coverage Related E/M Codes

2015 FP Notebook

20. Criteria for Switching From Intravenous to Oral Antibiotics in Patients Hospitalized With Community-Acquired Pneumonia

Compared to IV Antibiotics Abbreviations: CI, confidence interval; IV, intravenous; M-H, Mantel-Haenszel Because these studies were not designed to specifically evaluate criteria for switching, only indirect evidence was available. Therefore, the quality of evidence according to GRADE was low (Appendix 2). Criteria for Switching From Intravenous to Oral Antibiotics in Patients Hospitalized With Community-Acquired Pneumonia: A Rapid Review. November 2013; pp. 1–23 13 Conclusions In patients hospitalized (...) Criteria for Switching From Intravenous to Oral Antibiotics in Patients Hospitalized With Community-Acquired Pneumonia Criteria for Switching From Intravenous to Oral Antibiotics in Patients Hospitalized With Community-Acquired Pneumonia: A Rapid Review. November 2013; pp. 1–23 Criteria for Switching From Intravenous to Oral Antibiotics in Patients Hospitalized With Community- Acquired Pneumonia: A Rapid Review Health Quality Ontario November 2013 Evidence Development and Standards Branch

2013 Health Quality Ontario

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