E/M Coding & Reimbursement Alert
Coding:
Let These 3 Tips Lead You to New vs. Established Patient Clarity
You can collect more for new patients — but check these guidelines first. What's the d... Read more
Let These 3 Tips Lead You to New vs. Established Patient Clarity
You can collect more for new patients — but check these guidelines first. What's the d... Read more
Continuing Education:
Use This Guidance to Improve Your Coding Education Process
Check out these tips for more effective clinician communication. Coding education is an... Read more
Use This Guidance to Improve Your Coding Education Process
Check out these tips for more effective clinician communication. Coding education is an... Read more
Compliance:
Review This False Claims Act Case, Learn How to Avoid Big Fines
Strengthen your understanding of MDM guidelines. As you may know, the Department of Just... Read more
Review This False Claims Act Case, Learn How to Avoid Big Fines
Strengthen your understanding of MDM guidelines. As you may know, the Department of Just... Read more
You Be the Coder:
Simple or Complicated FBR?
Question: A patient reports to the ED after falling into a pile of branches while lan... Read more
Simple or Complicated FBR?
Question: A patient reports to the ED after falling into a pile of branches while lan... Read more
Reader Questions:
Lean on E/M Documentation for Services Not Actually Performed
Question: Can we count a provider's efforts to counsel a patient against a test as ev... Read more
Lean on E/M Documentation for Services Not Actually Performed
Question: Can we count a provider's efforts to counsel a patient against a test as ev... Read more
Reader Questions:
Check All the Boxes on Causalgia Dx Encounter
Question: A patient reports to the PM practitioner complaining of pain in their upper... Read more
Check All the Boxes on Causalgia Dx Encounter
Question: A patient reports to the PM practitioner complaining of pain in their upper... Read more
Modifiers:
Remember These 3 Rules for Modifier 25 Use
Separate, significant, and same day spell successful application. When you attach modifi... Read more
Remember These 3 Rules for Modifier 25 Use
Separate, significant, and same day spell successful application. When you attach modifi... Read more
Case Study:
Correctly Code These RSV Bronchiolitis Cases
Also: review the RSV testing codes. One of the most common diagnoses that pediatricians ... Read more
Correctly Code These RSV Bronchiolitis Cases
Also: review the RSV testing codes. One of the most common diagnoses that pediatricians ... Read more
Specialty Spotlight:
Eye These Encounter Elements When Coding Ocular FBR
Look closely at the documentation for these clues to determine the right code. A common ... Read more
Eye These Encounter Elements When Coding Ocular FBR
Look closely at the documentation for these clues to determine the right code. A common ... Read more
Reader Questions:
Choose E/M for Bruised Chest and Ribs Tx
Question: A new patient presents to the ED after falling from a balcony. The patient ... Read more
Choose E/M for Bruised Chest and Ribs Tx
Question: A new patient presents to the ED after falling from a balcony. The patient ... Read more
Reader Questions:
Proof of a Prescription is Not Proof of an E/M Service
Question: An established patient came in for a routine immunization. The physician's ... Read more
Proof of a Prescription is Not Proof of an E/M Service
Question: An established patient came in for a routine immunization. The physician's ... Read more
You Be the Coder:
Phone In this E/M Encounter
Question: A patient presented to the office for a follow-up appointment. When the patient... Read more
Phone In this E/M Encounter
Question: A patient presented to the office for a follow-up appointment. When the patient... Read more
MDM:
Apply Sports Medicine Know-How to Your E/M Understanding
Gain specific insight into the MDM elements. This time of year, school-aged athletes are ... Read more
Apply Sports Medicine Know-How to Your E/M Understanding
Gain specific insight into the MDM elements. This time of year, school-aged athletes are ... Read more
Surgical Packages:
Follow These Tips for Separately Billed Service Success
Surgical packages may be a glass half full/glass half empty situation. During his HEALTHC... Read more
Follow These Tips for Separately Billed Service Success
Surgical packages may be a glass half full/glass half empty situation. During his HEALTHC... Read more
Specialty Spotlight:
FYI on TPI: Know When You Can Code These Shots in the ED
Remember to count muscles injected. Therapeutic injections and infusions aren't typically... Read more
FYI on TPI: Know When You Can Code These Shots in the ED
Remember to count muscles injected. Therapeutic injections and infusions aren't typically... Read more
Reader Questions:
Lean on Documentation for E/M of Services Not Actually Performed
Question: Can we count a provider's efforts to counsel a patient against a test as ev... Read more
Lean on Documentation for E/M of Services Not Actually Performed
Question: Can we count a provider's efforts to counsel a patient against a test as ev... Read more
Reader Questions:
Meckel’s Ganglion Block
Question: A new patient with a dislocated right jaw is referred by the local hospital... Read more
Meckel’s Ganglion Block
Question: A new patient with a dislocated right jaw is referred by the local hospital... Read more
Reader Questions:
Know When ‘Procedures’ Don’t Get Procedure Codes
Question: One of my providers recently removed an ear piercing, and he documented tha... Read more
Know When ‘Procedures’ Don’t Get Procedure Codes
Question: One of my providers recently removed an ear piercing, and he documented tha... Read more
You Be the Coder:
A-lines and Critical Care
Question: A patient with acute respiratory failure with hypoxia is brought to the ED ... Read more
A-lines and Critical Care
Question: A patient with acute respiratory failure with hypoxia is brought to the ED ... Read more
Guidelines:
Bolster Your Distinct Time Billing Knowledge
Remember to bill with only one provider's number. Billing for split or shared services b... Read more
Bolster Your Distinct Time Billing Knowledge
Remember to bill with only one provider's number. Billing for split or shared services b... Read more
Best Practices:
Overcome 2023 E/M Update Challenges with Expert Advice
Get tips on how and when to query. For many coders, the evaluation and management (E/M) c... Read more
Overcome 2023 E/M Update Challenges with Expert Advice
Get tips on how and when to query. For many coders, the evaluation and management (E/M) c... Read more
Specialty Spotlight:
Test Your Knowledge of Pregnant Patient Annual Exams
Be cautious about what you use for your primary diagnosis. To ethically maximize your ob... Read more
Test Your Knowledge of Pregnant Patient Annual Exams
Be cautious about what you use for your primary diagnosis. To ethically maximize your ob... Read more
Reader Questions:
Make Friends With ‘Buddy Taping’ Code
Question: If the ED physician wraps tape around an injured toe and an adjoining one ... Read more
Make Friends With ‘Buddy Taping’ Code
Question: If the ED physician wraps tape around an injured toe and an adjoining one ... Read more
Reader Questions:
Count Provider Minutes When Performing Phone Visits
Question: A provider had a telephone visit with a patient to refill prescriptions for... Read more
Count Provider Minutes When Performing Phone Visits
Question: A provider had a telephone visit with a patient to refill prescriptions for... Read more
Reader Questions:
Rely on MDM Versus Time for This Fracture Encounter
Question: My physician's notes indicate that they performed an office evaluation and ... Read more
Rely on MDM Versus Time for This Fracture Encounter
Question: My physician's notes indicate that they performed an office evaluation and ... Read more
You Be the Coder:
Does This Case Call for E/M and Immunotherapy Codes?
Question: A patient comes to the office for his allergy shot. He complains of an ear... Read more
Does This Case Call for E/M and Immunotherapy Codes?
Question: A patient comes to the office for his allergy shot. He complains of an ear... Read more
Back to Basics:
Code These 4 Things to Bill 99211 Correctly
And learn these three reasons for not reporting it. When one of your clinical staff membe... Read more
Code These 4 Things to Bill 99211 Correctly
And learn these three reasons for not reporting it. When one of your clinical staff membe... Read more
Clip and Save:
Answer the How, What, When, and Why for Preoperative Evaluations
Don't forget to check for comorbid conditions. Knowing how to navigate and select all of ... Read more
Answer the How, What, When, and Why for Preoperative Evaluations
Don't forget to check for comorbid conditions. Knowing how to navigate and select all of ... Read more
Condition Focus:
Breeze Through Spring with Denial-Proof Allergy Coding
Debunk these three myths to sail through allergy diagnosis codes. With allergy season i... Read more
Breeze Through Spring with Denial-Proof Allergy Coding
Debunk these three myths to sail through allergy diagnosis codes. With allergy season i... Read more
Reader Questions:
Determine Your Dx After Cancer Surgery
Question: When can we bill a visit after a surgery for cancer? My colleague says that... Read more
Determine Your Dx After Cancer Surgery
Question: When can we bill a visit after a surgery for cancer? My colleague says that... Read more
Reader Questions:
Identify a COPD Exacerbation Dx With PFT
Question: A patient presented with chronic cough, wheezing, and difficulty breathing.... Read more
Identify a COPD Exacerbation Dx With PFT
Question: A patient presented with chronic cough, wheezing, and difficulty breathing.... Read more
Reader Questions:
Phone in This E/M Encounter
Question: A patient presented to the office for a follow-up appointment. When the pat... Read more
Phone in This E/M Encounter
Question: A patient presented to the office for a follow-up appointment. When the pat... Read more
You Be the Coder:
Go Par for the Golfer’s Elbow Dx Course
Question: Encounter notes that a patient reports to the orthopedist with complaints of pai... Read more
Go Par for the Golfer’s Elbow Dx Course
Question: Encounter notes that a patient reports to the orthopedist with complaints of pai... Read more
Procedure Focus:
Use These 6 Tips to Code Hearing Tests Successfully
Start by knowing what's included in an E/M visit. If your practice includes an audiologi... Read more
Use These 6 Tips to Code Hearing Tests Successfully
Start by knowing what's included in an E/M visit. If your practice includes an audiologi... Read more
Coding Quiz:
Evaluate Your E/M and Spirometry Procedure Coding Knowledge
Find out if your coding skills are on point. As a pulmonology coder, evaluation and man... Read more
Evaluate Your E/M and Spirometry Procedure Coding Knowledge
Find out if your coding skills are on point. As a pulmonology coder, evaluation and man... Read more
Specialty Spotlight:
Take a Second Look at MDM Table
Does data factor into this ED E/M claim? Given the recent and extensive changes to the ev... Read more
Take a Second Look at MDM Table
Does data factor into this ED E/M claim? Given the recent and extensive changes to the ev... Read more
Coding Quiz Answers:
Check Your E/M and Spirometry Coding Answers
Find out what a ‘B' status means in the MPFS. Check to see if your answers from the que... Read more
Check Your E/M and Spirometry Coding Answers
Find out what a ‘B' status means in the MPFS. Check to see if your answers from the que... Read more
Reader Questions:
Know When Procedures Don’t Get Procedure Codes
Question: One of my providers recently removed an ear piercing, and he documented tha... Read more
Know When Procedures Don’t Get Procedure Codes
Question: One of my providers recently removed an ear piercing, and he documented tha... Read more
Reader Questions:
Check Whether QHP Performed Pump Refill
Question: If a patient has an implantable pump in their spine that the provider refil... Read more
Check Whether QHP Performed Pump Refill
Question: If a patient has an implantable pump in their spine that the provider refil... Read more
Reader Questions:
Know How to Navigate CPO
Question: We have a patient who is eligible for home care, and our gastroenterologist... Read more
Know How to Navigate CPO
Question: We have a patient who is eligible for home care, and our gastroenterologist... Read more
You Be the Coder:
Keep CPR, E/M Separate
Question: Can I report an emergency department (ED) evaluation and management (E/M) c... Read more
Keep CPR, E/M Separate
Question: Can I report an emergency department (ED) evaluation and management (E/M) c... Read more
Telehealth:
Use These Tips to Find More Efficacy With Telehealth
Plus: Save this chart for future reference. There's no denying that telehealth improves a... Read more
Use These Tips to Find More Efficacy With Telehealth
Plus: Save this chart for future reference. There's no denying that telehealth improves a... Read more
Leveling:
Consider This Leveling Advice for MDM
Evaluate all available information when determining risk. Assessing murky situations to d... Read more
Consider This Leveling Advice for MDM
Evaluate all available information when determining risk. Assessing murky situations to d... Read more
Specialty Focus:
Check Your Toe Injury Coding Knowledge
Distinguish between new and existing patients to assign the appropriate E/M code. Injurie... Read more
Check Your Toe Injury Coding Knowledge
Distinguish between new and existing patients to assign the appropriate E/M code. Injurie... Read more
Reader Questions:
Focus on Treatment Goals to Evaluate Condition Stability
Question: A patient with chronic pain presents for an evaluation and management (E/M)... Read more
Focus on Treatment Goals to Evaluate Condition Stability
Question: A patient with chronic pain presents for an evaluation and management (E/M)... Read more
Reader Questions:
Pay Attention to Diagnosis Specificity to Level E/M
Question: Does an undiagnosed new problem with uncertain diagnosis automatically mean... Read more
Pay Attention to Diagnosis Specificity to Level E/M
Question: Does an undiagnosed new problem with uncertain diagnosis automatically mean... Read more
Reader Questions:
Rely on MDM Versus Time for This Fracture Encounter
Question: My physician's notes indicate that they performed an office evaluation and... Read more
Rely on MDM Versus Time for This Fracture Encounter
Question: My physician's notes indicate that they performed an office evaluation and... Read more
You Be the Coder:
Count on Location for Rib Fracture X-Ray Views
Question: After a level 4 office evaluation and management (E/M) service for an esta... Read more
Count on Location for Rib Fracture X-Ray Views
Question: After a level 4 office evaluation and management (E/M) service for an esta... Read more
Coding Deep Dive:
Answer the How, What, When, and Why for Pre-Operative Evaluations
Don't forget to check for comorbid conditions. Knowing how to navigate and select all of ... Read more
Answer the How, What, When, and Why for Pre-Operative Evaluations
Don't forget to check for comorbid conditions. Knowing how to navigate and select all of ... Read more
FAQ:
Seek Clarity on New Pelvic Exam Code
Find out which Medicare codes aren't compatible. Many coders may not feel confident about... Read more
Seek Clarity on New Pelvic Exam Code
Find out which Medicare codes aren't compatible. Many coders may not feel confident about... Read more
Specialty Focus:
Find Security in Coding Vertebral Fractures
Hint: Consider E/M code to report the decision-making process. Coders who report surgery... Read more
Find Security in Coding Vertebral Fractures
Hint: Consider E/M code to report the decision-making process. Coders who report surgery... Read more
Reader Questions:
Don’t Mistake These Procedures for E/M Services
Question: I noticed that the physicians at the practice I just started working at tend to... Read more
Don’t Mistake These Procedures for E/M Services
Question: I noticed that the physicians at the practice I just started working at tend to... Read more
Reader Questions:
Remember This Modifier 25 Tip
Question: Should I always append modifier 25 for a minor procedure with an evaluation and ... Read more
Remember This Modifier 25 Tip
Question: Should I always append modifier 25 for a minor procedure with an evaluation and ... Read more
Reader Questions:
Understand Neonate-Specific Coding Conventions
Question: Our hospital physician provided a neonate with critical care throughout the firs... Read more
Understand Neonate-Specific Coding Conventions
Question: Our hospital physician provided a neonate with critical care throughout the firs... Read more
You Be the Coder:
Note E/M Exception in Debridement Procedure
Question: I have a provider who uses an operating microscope to debride the ear canal of â... Read more
Note E/M Exception in Debridement Procedure
Question: I have a provider who uses an operating microscope to debride the ear canal of â... Read more
Inpatient Coding:
Check In on Revisions Pertaining to Hospital Care
Review the newish codes and make sure you're doing things correctly. Coders responsible ... Read more
Check In on Revisions Pertaining to Hospital Care
Review the newish codes and make sure you're doing things correctly. Coders responsible ... Read more
Procedure Focus:
Explore Options for Reporting Osteotomy
Check how the decision for surgery was made. Coders responsible for reporting osteotomy ... Read more
Explore Options for Reporting Osteotomy
Check how the decision for surgery was made. Coders responsible for reporting osteotomy ... Read more
Knowledge Check:
Find Clarity Amidst MDM Coding Confusion
Hint: Look to MACs for guideline help. The gray areas inherent to medical decision maki... Read more
Find Clarity Amidst MDM Coding Confusion
Hint: Look to MACs for guideline help. The gray areas inherent to medical decision maki... Read more
Reader Questions:
Beware Addition of Urinalysis Code to E/M
Question: For all lab tests performed in the office, our nurse researches the history... Read more
Beware Addition of Urinalysis Code to E/M
Question: For all lab tests performed in the office, our nurse researches the history... Read more
Reader Questions:
Find CPAP Management Amidst E/M Bundle
Question: I'm new to pulmonology coding, and I have an encounter note for a recent ev... Read more
Find CPAP Management Amidst E/M Bundle
Question: I'm new to pulmonology coding, and I have an encounter note for a recent ev... Read more
Reader Questions:
Find Synonyms for Myofibrositis
Question: Encounter notes indicate that a physician provided an office evaluation and... Read more
Find Synonyms for Myofibrositis
Question: Encounter notes indicate that a physician provided an office evaluation and... Read more
You Be the Coder:
Explore Cerebellar Abscess Diagnostic Process
Question: Notes indicate that the surgeon performed a level 4 office evaluation and m... Read more
Explore Cerebellar Abscess Diagnostic Process
Question: Notes indicate that the surgeon performed a level 4 office evaluation and m... Read more
Procedure Deep Dive:
Clean Up Your Vasectomy Coding Claims
Use these coding hints to snip through any confusion. Coders working with urologists or ... Read more
Clean Up Your Vasectomy Coding Claims
Use these coding hints to snip through any confusion. Coders working with urologists or ... Read more
Specialty Spotlight:
Code Pessary Encounters Confidently
Hint: You may be able to report multiple E/M services in some situations. Coding pessary ... Read more
Code Pessary Encounters Confidently
Hint: You may be able to report multiple E/M services in some situations. Coding pessary ... Read more
Expert Opinion:
Find Out How Emergency Departments Might Fare With MPFS in 2024
Enjoy some long-awaited clarity on split/shared services. In 2024, the stars will align a... Read more
Find Out How Emergency Departments Might Fare With MPFS in 2024
Enjoy some long-awaited clarity on split/shared services. In 2024, the stars will align a... Read more
Reader Question:
Understand When Telehealth Can Replace a Face-to-Face Visit
Question: My provider wants to bill 99350 when performing a home visit via telehealth... Read more
Understand When Telehealth Can Replace a Face-to-Face Visit
Question: My provider wants to bill 99350 when performing a home visit via telehealth... Read more
Reader Question:
Don’t Forget Alternate Terms for MS
Question: Encounter notes indicate that the provider treated a new patient with multi... Read more
Don’t Forget Alternate Terms for MS
Question: Encounter notes indicate that the provider treated a new patient with multi... Read more
Reader Question:
Decipher Cancer Care Follow-Up Details
Question: I have two questions regarding follow-up appointments for the prostate pat... Read more
Decipher Cancer Care Follow-Up Details
Question: I have two questions regarding follow-up appointments for the prostate pat... Read more
You Be the Coder:
Find Solution for Nursemaid Elbow
Question: A 8-year-old boy presented with a dislocated right elbow. After examination... Read more
Find Solution for Nursemaid Elbow
Question: A 8-year-old boy presented with a dislocated right elbow. After examination... Read more
Evaluation and Management:
Document These Aspects of Drug Management for E/M Service
Question: When is an evaluation and management service of medication justified? RCI Subsc... Read more
Document These Aspects of Drug Management for E/M Service
Question: When is an evaluation and management service of medication justified? RCI Subsc... Read more
E/M Coding:
Don’t Round Up Encounter Time
Question: One of my colleagues has a habit of rounding up the time our provider spends wit... Read more
Don’t Round Up Encounter Time
Question: One of my colleagues has a habit of rounding up the time our provider spends wit... Read more
E/M Coding:
Follow This Guidance for Flawless E/M Coding (Part 1)
Don't get caught out watching the clock. You may think you have a handle on office/outpat... Read more
Follow This Guidance for Flawless E/M Coding (Part 1)
Don't get caught out watching the clock. You may think you have a handle on office/outpat... Read more
E/M Coding:
Separate Diagnoses Can Support MDM Leveling
Question: A provider sees a patient and documents these diagnoses after the encounter: sho... Read more
Separate Diagnoses Can Support MDM Leveling
Question: A provider sees a patient and documents these diagnoses after the encounter: sho... Read more
Medicare Regulations:
Find Clarity on Medicare Telehealth POS Codes
Question: My provider sometimes uses technology to see Medicare beneficiaries in their hom... Read more
Find Clarity on Medicare Telehealth POS Codes
Question: My provider sometimes uses technology to see Medicare beneficiaries in their hom... Read more
E/M Coding:
Follow This Guidance for Flawless E/M Coding (Part 2)
Get down to the nitty gritty of the MDM elements. Last month, we looked at advice Angela ... Read more
Follow This Guidance for Flawless E/M Coding (Part 2)
Get down to the nitty gritty of the MDM elements. Last month, we looked at advice Angela ... Read more
E/M Coding:
Try These Three Questions to Determine Modifier 24 Usage
Question: What are the proper situations to use modifier 24? My colleague says that y... Read more
Try These Three Questions to Determine Modifier 24 Usage
Question: What are the proper situations to use modifier 24? My colleague says that y... Read more
E/M Coding:
Could You Be Accused of Upcoding for Your Level 4 E/M Code Selections?
Hint: Never forget medical necessity when selecting codes. Ever since the evaluation and ... Read more
Could You Be Accused of Upcoding for Your Level 4 E/M Code Selections?
Hint: Never forget medical necessity when selecting codes. Ever since the evaluation and ... Read more
E/M Coding:
Code Cerumen Encounter Based on Method of Removal
Question: Are multiple procedure codes required for a physician to both diagnose and treat... Read more
Code Cerumen Encounter Based on Method of Removal
Question: Are multiple procedure codes required for a physician to both diagnose and treat... Read more