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E/M Coding & Reimbursement Alert
E/M Coding & Reimbursement Alert
E/M Coding & Reimbursement Alert - 2014; Volume 2, Number 12
Correct Coding Initiative:
Update Your Coding with 3 Sets of CCI 20.3 E/M Edits
Take advantage of the bundles with a ‘1’ modifier indicator and get paid for...
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Key Elements:
Avoid 5 Common E/M Errors With These Expert Tips, Part 2
Find out why under-coding is just as bad as over-coding. Falling into common E/M codin...
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Clip and Save:
Keep This CCI 20.3 Edits Table Handy to Help Make Your E/M Coding More Efficient
Knowing when you can use a modifier to seek separate E/M payment will add dollars to you...
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Correction
In the Vol. 2, No. 10 issue of the E/M Coding Alert, the article titled “Get to Kn...
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Reader Question:
Use Consult Info in Your MDM
Question: Our gastroenterologist consulted with a patient that was referred to her ...
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Reader Question:
30-Day TCM is the Key to E/M
Question: An 84-year-old female patient of ours who experienced congestive heart fa...
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Reader Question:
Identify Patient as Established for 99231-99233
Question: On a recent claim, I used a CPT® code for subsequent hospital care to...
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You Be the Coder:
Admission Status Helps You Determine E/M
Question: A patient at 38 weeks gestation presented to her ob-gyn office saying her...
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E/M Coding & Reimbursement Alert - 2014; Volume 2, Number 11
Key Elements:
Avoid 5 Common E/M Errors With These Expert Tips, Part 1
Find out why under-coding is just as bad as over-coding. No matter how many years or e...
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CMS Payment Policy:
Watch for 0-Day Global Periods on All Codes, CMS Says
You may be paid individually for all the services performed in the global period. CMS ...
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Pediatric Critical Care:
Implement the Updated 99466-99467 Reporting Guidelines
The ‘by land, air, or water’ place of service code is necessary for a comple...
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Reader Question:
Trust Your Choice of 99318 with Annual NF E/M
Question: My physician performed an annual E/M for her NF patient. She reviews the ...
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Reader Question:
Use 99253 When Payer Accepts Consult Codes
Question: Our vascular surgeon performed an inpatient consultation for acute ischem...
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Reader Question:
Keep an Eye on Chronic Care Payment Rate
Question: What is the final rule from CMS on the payment rate change for care manag...
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Reader Question:
Report Office and OR E/M on Same Day
Question: Our physician saw a one-year-old established patient that fell out of a s...
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You Be the Coder:
Pair Up Immunotherapy with E/M Service
Question: My pulmonologist assessed a patient suffering from severe pain and fever ...
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E/M Coding & Reimbursement Alert - 2014; Volume 2, Number 10
CPT® 2015:
Get to Know Next Year's Chronic Care Management Code Changes
A new code allows reimbursement for CCM non-face-to-face time. If you have been wonder...
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ICD-10:
Mark Your 2015 Calendar for New ICD-10 Release Date
Use this time to test your systems to eliminate pain later. Whether you’re ...
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Inpatient Coding:
Determine When and What to Charge with a DOA
Don’t miss out on reimbursement by not reporting 99238. Whether or not you are a...
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Otolaryngology Spotlight:
Uncover When E/M Code Goes Hand in Hand with Coding Cerumen Removal
Separate the E/M from 69210 with modifier 25 to get deserved dollars. When your provid...
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Reader Question:
Decipher Notes to Code the Accurate Level
Question: An established 22-year-old male patient was seen and our physician docume...
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Reader Question:
Look Closely at the HEM to Pick 99201 or 99202
Question: After my physician performed a problem-focused history and examination on...
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Reader Question:
Don't Mix Related E/Ms During Global Periods
Question: We have a patient that had surgery with a 90-day global period on July 4....
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Reader Question:
Separate Primary Visit from Prolonged Service
Question: During a scheduled office visit of a new patient, our cardiologist spent ...
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You Be the Coder:
Forms to Complete? Consider 99080 with an Office Visit
Question: My physician completed forms relating to the Family and Medical Leave Act...
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E/M Coding & Reimbursement Alert - 2014; Volume 2, Number 9
Correct Coding Initiative:
Update Your 99201-99215 Coding, Thanks to CCI 20.2
You can exhale: Modifier indicator “1” outnumbers “0” on E/M bun...
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Quick Quiz Answers:
Challenge Yourself With 3 Global Surgery Package Answers
Take charge of your E/M training and evaluate yourself. Your E/M education is ongoing,...
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Billing Spotlight:
Get Comfortable with Unruly Consolidated Billing Rules
Uncover who, what, and when to bill so you get your money. Knowing whether your skille...
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Picture This Example of Consolidated Billing
Knowing the patient’s residence status will prevent denials. A physician sees...
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Reader Question:
Break Up 99363 and 99364 in Anticoagulant Management
Question: We have a patient that comes into the office and requires anticoagulant m...
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Reader Question:
Prove Medical Necessity for 11721 with 99213
Question: Can I bill Medicare for an E/M visit (99213) along with a debridement of ...
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You Be the Coder:
Question Coding 99420 Separately From E/M
Question: A patient of one of our providers came in for an annual wellness visit an...
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E/M Coding & Reimbursement Alert - 2014; Volume 2, Number 8
News You Can Use:
Calculate HEM with Less Effort, Thanks to Guidelines Change
Remember the exam is the last criterion that differs from 1995 to 1997 guidelines. CMS...
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Clarify the HPI Guidelines Change with an Example
Break down your options and see which gives you highest code level. With the new Me...
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Quick Quiz:
Challenge Yourself with 3 Global Surgery Package Questions
Take charge of your E/M training and evaluate yourself. Understanding how the post-ope...
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Hospital Inpatient:
Don't Fret, 99221-99223 Replace Consult Codes
Adopt modifier AI when there’s more than one initial care performed. Because, as...
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Reader Question:
Code to Reflect the Extent of the Physician Discussion
Question: We have patients provide their chief complaint/reason for visit, history ...
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Reader Question:
Sharing Services in Global Period Means Share the Pay
Question: A physician of mine diagnosed a hip fracture and performed the surgery he...
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Reader Question:
Give a Reason for Interpretation #2
Question: I work in a new ob-gyn practice with a new provider/specialty: a urogynec...
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You Be the Coder:
Consider Including Telephone E/M in History or MDM
Question: We have a new patient that called his physician to discuss his visit that...
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E/M Coding & Reimbursement Alert - 2014; Volume 2, Number 7
Prolonged Services:
Focus on 3 Tips to Capture Deserved Extra Pay With +99354-+99357
Multiply your reimbursement by ensuring your physicians are using their watch to note ac...
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Nursing Facility Coding:
Understand and Separate "Initial" From "Subsequent" Care When Coding
Better your chances for a proper reimbursement by having the correct POS. When your ph...
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Newborn Care Services:
Cut Down on Errors by Separating Newborn From Sick Codes
Use just one diagnosis code with a normal newborn CPT®. Birth through 28 days is t...
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Reader Question:
Untangle the Encounter Details to Code a Pre-Op Clearance
Question: A Medicare patient came in to see our pulmonologist to get clearance for ...
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Reader Question:
Tread Carefully When Coding Follow-up Visits
Question: I read your article titled “Consider the Facts to Determine Fractur...
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Reader Question:
Skip 99397 for Medicare
Question: We have a 70-year-old patient that came in for a reevaluation and managem...
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Reader Question:
1 Patient + 2 issues + 1 Visit = 1 E/M
Question: A patient came in to our office complaining she had postnatal depression....
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You Be the Coder:
Consider the Need to Administer Medication When Coding 99211
Question: We have a patient in our practice that comes in for her prothrombin time ...
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E/M Coding & Reimbursement Alert - 2014; Volume 2, Number 6
Global Periods:
Wrap Your Arms Around What Global Surgical Packages Mean to E/M
Receive separate payment when conditions allow. Knowing the number of post-operative d...
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News You Can Use:
Bill Signed into Law Delays Your Pay Cuts and ICD-10 Implementation
Experts hope that a long-term solution to the SGR formula will be secured. The Protect...
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Specialty Focus -- Orthopedic:
Consider the Facts to Determine Fracture Care or a Possible E/M
Hold on to your $ when choosing a fracture or casting code. When your physician sees a...
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Reader Question:
Track Post-Op Visits With 99024
Question: One of the doctors in our group saw a new patient in the emergency room f...
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Reader Question:
Make a Call to the Payer to Determine Whether E/M is Bundled With Surgery
Question: We had a patient present to the office for a relatively minor problem. Ou...
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Reader Question:
Use 99499 When a Service Doesn't Reflect a Code Description
Question: Can I use modifier 52 on 99201 if my provider only captures history and M...
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You Be the Coder:
Ask Payer For Preferred Consult Code
Question: When I use 99283 and 99284 I constantly get denied by my payer. My doctor...
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E/M Coding & Reimbursement Alert - 2014; Volume 2, Number 5
Correct Coding Initiative:
Dive Into the CCI 20.1 Edits and Ward Against Rejected Claims
New E/M bundles concentrate on clinical immunology. You’ll have to add a slew of...
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Quiz Answers:
Grade Yourself to See If You Can Avoid Critical E/M Errors
Hone your E/M skills with the answers to the quiz from last month’s issue. If yo...
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ICD-10:
Be More Specific With Two Child Health Exam Codes
Splitting V20.2 in two allows with and without abnormal findings. When ICD-9 is replac...
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ICD-10 Delayed Another Year
As of Tuesday, April 1, President Obama signed the Protecting Access to Medicare Act of ...
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Reader Question:
No Modifier When E/M is Months Prior to Injection
Question: If a doctor injects a high-end injectable such as Synvisc, Hyalgan, Ortho...
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Reader Question:
Avoid Duplicating E/M Services
Question: We had a 44-year-old come in to see her physician for her wellness visit ...
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You Be the Coder:
Back Up and Master E/M Levels of Service
Question: Does an extended HPI guarantee a higher-level E/M code? Washington Subs...
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E/M Coding & Reimbursement Alert - 2014; Volume 2, Number 4
Inpatient Coding:
Be Aware of the New Inpatient Definition or Face Denials
Expect exceptions when using the “two-midnight” rule. In the updated...
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Preventive Services:
Nab Separate Pay for Preventive and Problem-Oriented Visits with These Tips
Beware: Coding preventive medicine encounters as problem visits is a problem. When a p...
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Quick Quiz:
Test Yourself to Avoid These Critical E/M Errors
Use this quiz to identify where you need to focus your learning. One of the most effic...
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Outpatient E/M:
Embrace 99211 Regulations to Avoid Losing $20 per Encounter
Turn thorough documentation into successful claims. Evaluations of established patient...
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Reader Question:
Giving a Helping Hand Is a Shared Service
Question: My physician and a physician’s assistant visited the same patient i...
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Reader Question:
Master Coding Within Global Period
Question: One of the surgeons in my practice had a patient make an appointment to c...
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Reader Question:
Focus on Level of Physician Involvement For Incident To
Question: My physician has a patient that requires anti-coagulation monitoring in t...
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Reader Question:
Separating E/M From NCS Requires HEM
Question: Is it appropriate to bill an E/M in addition to a nerve conduction study ...
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You Be the Coder:
Emergency vs. Critical
Question: One of the physicians in my office went to the emergency department to me...
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E/M Coding & Reimbursement Alert - 2014; Volume 2, Number 3
Mind Your Modifiers:
Save Time By Understanding When to Use Modifier 57
Knowing why a claim with modifier 57 is denied, may help your appeal. Modifier ...
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Things for you to remember about modifier 57
Use for E/M services only. Use when an E/M service results in a surgery. Make...
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Hospital E/M:
Follow These 5 Steps and Become a Pro With Subsequent Hospital Care Coding
Practicing each of these steps may increase your practice’s reimbursement. If y...
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Reader Question:
Gotta Have That HEM
Question: A patient came into the office to see our orthopedist to receive a knee inject...
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Reader Question:
Review New Patient Definition
Question: A patient came in to see our general surgeon in December and had a unilateral ...
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Reader Question:
Reporting Physician Procedure Subspecialty Avoids Denial
Question: We are in a large GI group all under the same tax ID. One of our physici...
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Reader Question:
'Unable to Communicate' Caveat Only Applies to History
Question: I need help with the E/M for a patient with dementia. The patient took a fall ...
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You Be the Coder:
Be Sure to Hit 8 With Observation Coding
Question: My physician saw a patient in observation status but discharged the patient be...
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E/M Coding & Reimbursement Alert - 2014; Volume 2, Number 2
Hospital E/M:
Follow 5 Tips for Solid Discharge Service Coding
Time isn’t the only key to correctly using 99238-99239. With only two codes to p...
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Specialty Focus - Internal Medicine:
Skipping Tests, Screenings With Preventive Medicine Codes Will Cost Your Practice Hundreds
Pay attention to modifier 25 requirements to help ensure payment. You know that you sh...
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Reimbursement:
Rejoice In Conversion Factor Increase Rather Than Decrease
Hope for additional changes before the end of March. Like most practices, you were pro...
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CPT® 2014:
Check CPT® Errata for 'Qualified Health Care Professional' Clarification
Update your 2014 manual to reflect the changes. The AMA has updated its 2014 (and 2013...
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Reader Question:
New CMS-1500 Coming Soon
Question: How will the CMS 1500 form change to allow ICD-10-CM reporting? Vermont Subs...
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Reader Question:
Patient 'Coding' Doesn't Automatically Mean 99291
Question: After a patient with chest pain “coded” in the ER and was admitted...
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Reader Question:
Physicians Can't Bill Incident to Each Other
Question: I have a case where one physician (physician A) in my practice covered an esta...
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Reader Question:
Ensure Face-to-Face Counseling for 99407 with 99213
Question: I am billing 99407 with 99213 and getting denials. I have used the modifier 25...
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You Be the Coder:
Separate Hospital Stay -- 99468 or 99469?
Question: Our pediatrician admits a newborn baby with severe respiratory distress and we...
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E/M Coding & Reimbursement Alert - 2014; Volume 2, Number 1
Diagnosis Coding:
Scour the Documentation for a Solid Diagnosis When Your Provider Forgets to Pick One
When in doubt, go back to your provider for details. At some point, a superbill will c...
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Quick Quiz:
Evaluate Your Own E/M Coding Skills With 3 Test Questions
Test your skills with these questions to see where you should focus your E/M education. ...
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Reimbursement:
January Will Bring a 24.4 Percent Pay Cut Unless Congress Steps In
Good news: If you do chronic care management, watch for pay on non-face-to-face services...
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Reader Question:
2 Surgeons, 1 Practice = 1 Code on Same Day
Question: Two neurosurgeons in our practice treated a post-trauma patient twice on the s...
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Reader Question:
Medication Isn't the Only Factor in E/M Level
Question: Since prescription management involves moderate risk on the CMS standard docum...
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Reader Question:
Define 'Calendar Date' For Proper Billing
Question: The CPT® surgery guidelines state that the surgical package includes &ldqu...
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You Be the Coder:
Coding for 911 Call
Question: One of our patients presented for a sick visit but was so ill that the physica...
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Available Years:
2014
2013