E/M Coding & Reimbursement Alert

E/M Coding & Reimbursement Alert - 2013; Volume 1, Number 10

Specialty Focus -- Ob-gyn:
Knowing Your Payer is the Key to Unlocking Annual Physical + Pap Services
Tip: Not all payers follow the CPT® manual guidelines. When your physician &mdash... Read more

Payer Focus:
Watch Out for 2 E/M Error Hotspots CMS Uncovered
Shine a light on your inpatient and allergy claims first. Even if your practice report... Read more

News You Can Use:
CERT Results Show E/M Errors Top the Problem List
CMS finds 14.0 percent improper E/M payment rate. If your practice’s collections... Read more

Reader Question:
Choose Between 3 ROS Levels
Question: Our providers are having trouble understanding what levels of ROS there are. C... Read more

Reader Question:
Check This Tip for Procedure-Day E/M
Question: Our physician saw a patient in the office and performed wound care. There w... Read more

Reader Question:
Flu-Shot-Only New Patients Pose Coding Challenges
Question: We are trying to decide how to handle new patients who want to come in just fo... Read more

Reader Question:
Place of Service Determines Code Selection
Question: A patient presented at our office with a bruise. Our pediatrician examined the... Read more

Reader Question:
Not All Follow-ups Are Created Equal
Question: We recently finished our first internal audit and found a potential issue: One... Read more

Reader Question:
Diagnosis Matters for Routine Hip Replacement Visit
Question: Which diagnosis code should we report for a patient who comes in for a routine... Read more

Reader Question:
Modifier 25 Trumps 59
Question: Our payer is denying a claim involving an E/M and a fine needle aspiratio... Read more

You Be the Coder:
99213 or 99214?
Question: My ob-gyn documented the following: Established patient CC: Vaginal Disc... Read more

E/M Coding & Reimbursement Alert - 2013; Volume 1, Number 9

Test Yourself:
Hone Your E/M Coding Skills With 5 FAQs
Pinpoint where you need a refresher. With a slew of E/M coding rules and difference be... Read more

History How-To:
Point Your Provider in the Right Direction With These 5 History Tips
Beware of counting elements in more than one place. The task seems simple: The practit... Read more

Compliance:
Determine Whether Your Provider's Signature Will Withstand Compliance Scrutiny
Hint: Legibility does matter. Without your provider’s signature, encounter docum... Read more

Clip and Save:
Don't Rely on Signature Stamps For Compliance
Tackle the signature challenge with this handy chart. Learning the ins and outs of wha... Read more

Reader Question:
Comp History Is Not a Given
Question: Our physician admitted someone as an initial inpatient, but couldn’... Read more

Reader Question:
Check for Interruption Before Reporting 99058
Question: A mother called and reported her baby was having trouble breathing. A nur... Read more

Reader Question:
Go Ahead and Bill Parking Lot Services
Question: How do I bill a service that took place in our parking lot? The daughter ... Read more

Reader Question:
Modifier 25 Is Your Nebulizer + E/M Answer
Question: I just received a denial after reporting 99213 with 94664 (Demonstration ... Read more

Reader Question:
Count Your Way to 99441-99443 Success
Question: A patient leaves a message seven days after the previous related E/M vis... Read more

Reader Question:
High-Risk Doesn't Automatically Equal High Coding
Question: Our neurologist saw a 16 year-old patient with an established diagnosis o... Read more

You Be the Coder:
Same-Day Admission Trumps In-Office E/M
Question: Our physician saw a patient in the office, then admitted her to the hospi... Read more

E/M Coding & Reimbursement Alert - 2013; Volume 1, Number 8

CPT® 2014:
Rejoice in Limited E/M Coding Changes Brought By CPT® 2014
If you thought 2014 would bring an end to consultation coding confusion, think again. ... Read more

Correct Coding Initiative:
Facing New Modifier 25 Denials? CCI 19.3 Implementation Errors May Be at Fault
You’ll have three options for recouping your reimbursement. The newest update to... Read more

Specialty Focus -- Pulmonology:
Focus Your Diagnosis Coding for Pre-Op Clearance Encounters
Know when you can — and can’t — report an E/M service before surgery. ... Read more

Reader Question:
Check With Payer Before Adding SA
Question: When the NP provides unsupervised services, I bill the codes under the nurse p... Read more

Reader Question:
Lean On E/M Code for Tube Irrigation
Question: Is there a code for a nephrostomy tube irrigation done in the office? Orego... Read more

Reader Question:
AMA Advises 59, Not 25 for Same-Day E/M
Question: Can you advise regarding a successful way to get Medicare to pay for two emerg... Read more

Reader Question:
Count Your Way to 99234-99236 Success
Question: Our general surgeon admitted a patient to the hospital at 10:30 a.m., and late... Read more

You Be the Coder:
Match POS Code and Provider Type
Question: I am receiving denial C0-170 (Payment is denied when preformed/billed by this ... Read more

E/M Coding & Reimbursement Alert - 2013; Volume 1, Number 7

Critical Care:
Focus on Patient Condition When Deciding on 99291/99292
Tip: Get your provider to spell out time spent. Whether your providers perform critic... Read more

Critical Care:
Support Your Critical Care Thinking With This Official CMS and MAC Guidance
Knowing the critical care coding rules and getting your providers to understand them are... Read more

Incident-to Billing:
Leverage NPP Help While Collecting Full Reimbursement With These 3 Tips
Remember to confirm direct supervision first. Your practice is adding a physi... Read more

Clip and Save:
Follow This Path to Incident-To Billing Success
Verify physician supervision before sending the claim. Incident-to billing can help y... Read more

Reader Question:
Provider Holds Ultimate Coding Responsibility
Question: One of our physicians allows his medical assistant to choose his E/M codes. Th... Read more

Reader Question:
Count the Minutes for Family Counseling Session Coding
Question: My oncologist did a counseling session with the parents of a minor regarding t... Read more

Reader Question:
OTC Dosage Decisions Don't Automatically Increase MDM
Question: I have a provider who has stated that if he recommends that a patient take OTC... Read more

You Be the Coder:
Combine 2 Same-Day Face-to-Face Encounters
Question: Our neurologist saw a patient in the office, then admitted her to the hospital... Read more

E/M Coding & Reimbursement Alert - 2013; Volume 1, Number 6

Key Elements:
Follow 3 Tips to Take the Risk Out of MDM Calculations
Break out your math skills to determine what level your provider reaches. One of the m... Read more

Specialty Focus -- Psychiatry:
Get a Grip on 2013 Psych Coding Changes Before Payers Come Knocking
Combat payer denials with solid code know-how. If your practice bills psychiatric cod... Read more

Clip and Save:
Quickly Add Up the MDM Points With This Easy-to-Follow Worksheet
Translate your provider’s documentation into an MDM level. Even if math is not y... Read more

Reader Question:
Don't Automatically Assign Comprehensive History
Question: Our physician admitted someone as an initial inpatient, but couldn’t get... Read more

Reader Question:
When Available, Code Final Dx
Question: I’ve been told that if the treating physician orders a test based on a s... Read more

Reader Question:
Count 99173 Part of G0402
Question: I’m trying to understand what we can bill to Medicare during a patient&r... Read more

Reader Question:
Clearly Document Who Makes Amendments
Question: If and when the patient’s electronic health medical records needs to be ... Read more

You Be the Coder:
Sort Out This Complicated POS Case
Question: I have trouble figuring out how to charge for a patient that was in observatio... Read more

E/M Coding & Reimbursement Alert - 2013; Volume 1, Number 5

Key Elements:
Choose the Right Physical Exam Guidelines Every Time to Ensure Top Payment + Compliance
Hint: You don’t have to choose 1995 or 1997 and stick with it. Having two sets o... Read more

Modifiers:
Follow 3 Steps to Solidify Your Modifier 25 Use, Before Your Payers Come Knocking
Don’t confuse 25 and 57; look to the global period. Payers are scrutinizing and ... Read more

Modifier 25 vs. Modifier 57
Your modifier 25 claims should meet all of the following criteria: The E/M occurs o... Read more

Clip and Save:
Keep This Chart Handy to Help Quickly Calculate Exam Levels
Be sure you choose the guidelines that will be most advantageous to your coding. With... Read more

Reader Question:
Stress Time Documentation Requirement for Discharge Coding
Question: The doctor admitted a patient and then discharged the patient five days later.... Read more

Reader Question:
Include Phone Work in Next E/M Code
Question: From his office an oncologist reviews lab test results and, by telephone, orde... Read more

Reader Question:
Check for Bundling Before Attaching Modifier
Question: Sometimes I cannot find the two codes I intend to bill in the CCI edits. How d... Read more

Reader Question:
ICU Does Not Automatically Support 99291-99292
Question: After a patient with chest pain “coded” in the ER and was admitted... Read more

Reader Question:
Identify 3 'Vitals' Before Adding to Exam
Question: Would you please explain how taking the vital signs contributes to determining... Read more

Reader Question:
Assign a Physician, Not PA, for Initial NF Visits
Question: I am receiving denial C0-170 (Payment is denied when preformed/billed by this ... Read more

You Be the Coder:
Don't Automatically Combine ER and Office Visits
Question: If a patient was seen for an office visit (99214) first and then later on the ... Read more

E/M Coding & Reimbursement Alert - 2013; Volume 1, Number 4

Global Periods:
Know When You Can -- and Can't -- Report an E/M Service During a Procedure's Global Period
Learn the 7 global period designations to make your job easier. Before you even start... Read more

Key Elements:
Don't Let 1 Missing PMFSH Point Cost Your Practice $70 Per Encounter
Your provider’s notes about reviewing previously captured history are crucial. O... Read more

Aspects of PMFSH
Per CPT®, past medical, family and/or social history is divided into three subsectio... Read more

Clip and Save:
Get Patient Help Capturing PMFSH Details With a Template Form
Caution: Make sure the provider documents review of form. Going through a patient&rsqu... Read more

Reader Question:
Ensure Unrelated Problem Before Coding 2 E/Ms on 1 Day
Question: Can we bill two office visits on the same day? We reported 99214 twice for the... Read more

Reader Question:
Get Specific with Family History Notations
Question: Our physician often records the word “none” under the “famil... Read more

Reader Question:
Avoid Skirting the System to Save Patients Money
Question: We have a patient who wants us to directly bill her allowable charges for a pr... Read more

You Be the Coder:
Check For Time Notes on Discharge Coding
Question: The physician admitted a patient and then discharged the patient five days lat... Read more

E/M Coding & Reimbursement Alert - 2013; Volume 1, Number 3

CPT® 2013 Review:
Ensure You Prevent 'Physician' Limitations By Updating Your 2013 E/M Code Know-How
Revised descriptors clarified who can report several codes. By now, you should be well... Read more

Clip and Save:
Help Your Providers Capture All Pertinent ROS Details With This Handy Tool
Prevent ‘all systems negative’ notations with a comprehensive form. An eas... Read more

Specialty Focus -- Pediatrics:
Avoid Selecting E/M Levels Based on Diagnosis Cues
Here’s why you can’t assume a diagnosis always equates to a 99212, 99213, or... Read more

Key Elements:
Solidify ROS Documentation to Support Level 4 and 5 Encounters
With only one countable ROS element, you will be forced to choose a lower code every tim... Read more

Reader Question:
Say Yes to Time-Based E/M Plus Preventive E/M Coding
Question: Can we use time to select a second E/M code even if the other service code isn... Read more

Reader Question:
Include Dressing Change In Procedure Global
Question: Our patient had an abscess on her leg that was treated several days ago. Today... Read more

You Be the Coder:
Consider CC Codes for In-Office Grand Mal
Question: Our doctor saw two patients who left the office by ambulance. One was in res... Read more

E/M Coding & Reimbursement Alert - 2013; Volume 1, Number 2

Mythbuster:
Debunk 3 EHR Myths That Could Be Setting You Up for Payer Audits
Relying too much on your electronic system could be costing your practice big money. M... Read more

Key Elements:
Differentiating Brief vs. Extended HPI Will Pave the Way to 99204/5 and 99214/5 Success
Know when you can, and can’t, count duration. If you’re not accurately acc... Read more

Modifiers:
Bust 5 Common Modifier 24 Myths and Overcome E/M Denials
Tip: Look for a new problem before attaching 24. When your provider sees a patient who... Read more

Clip and Save:
Get the HPI Information You Need With This Checklist
Make your provider’s job easier by providing a list of questions to cover. In &l... Read more

Reader Question:
Scour for Details Before Coding
Question: My physician reported established patient office visit code 99213, but the onl... Read more

Reader Question:
Vitals Aren't Critical to Code Choices
Question: A daughter brought her mom to our office. The mother was seen by the doctor, b... Read more

Reader Question:
LCDs Override NCDs, CMS Says
Question: Our local MAC has a policy stating that only physicians can perform a particul... Read more

Reader Question:
Extensive Documentation Does Not Automatically Warrant Level 5
Question: Our physician is an amazing documenter — for established patients (which... Read more

Reader Question:
ED Codes = Not Just for ER Docs
Question: An emergency department (ED) physician asked our doctor to see a patient. The ... Read more

You Be the Coder:
Report 99291 Just Once Per Day
Question: When two physicians of the same specialty and group practice provide critical ... Read more

E/M Coding & Reimbursement Alert - 2013; Volume 1, Number 1

Time-Based Coding:
Ensure Your Provider is Documenting 3 Key Points for Billing on Time Alone
Remember that counseling and coordination of care must dominate the encounter. If you&... Read more

Back to Basics:
Pay Attention to 3-Year Rule to Decide Between New vs. Established Codes
The location of the encounter won’t be the deciding factor. Even before you star... Read more

Clip and Save:
Follow this 5-Question Path to Find Out if the Patient is Really New
This tool will help you navigate the sometimes tricky new vs. established question. As... Read more

Reader Question:
Modifier 25 is Your E/M + Procedure Answer
Question: Can I bill Medicare for an office visit and cystoscopy on the same day u... Read more

Reader Question:
Capture Payment For Biopsy Result Discussion
Question: A patient came in for the biopsy report after a 90-day global procedure. The d... Read more

Reader Question:
Ensure Providers Indicate ROS Review
Question: I’ve heard that for an E/M visit, the physician is responsible for cert... Read more

Reader Question:
Remember Prolonged Service Codes for Extra Long Visits
Question: My pediatric physician spent 105 minutes with a new patient in the office. Is ... Read more

Reader Question:
Follow the 3 Key Components Rule for 99304-99306
Question: How do I code if our physician went to the nursing home to see Medicare patien... Read more

You Be the Coder:
New Patient Vitals Won't Make the 99203 Grade
Question: A new patient presented in our office. Past medical, social, and family histor... Read more

Available Years: 2013