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E/M Coding & Reimbursement Alert
E/M Coding & Reimbursement Alert
E/M Coding & Reimbursement Alert - 2015; Volume 3, Number 12
Reimbursement:
Make Sure Your E/M Claims Aren't Part of the 14.6 Percent Error Rate
NPP claims are part of the problem. Evaluation and management coding and “&ldqu...
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Hospital Policy:
Ensure You're Ready For New NOTICE Requirements
Good news: You may already be doing what you need to do. As you learned in “Look...
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Reader Question:
Easily Identify E/M vs. Eye Codes
Question: I just started at an ophthalmology practice and am having trouble figurin...
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Reader Question:
Consult NCDs and LCDs Both
Question: Can you help me understand the difference between NCDs and LCDS? Do we ha...
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Reader Question:
Focus on the Final Diagnosis
Question: A 14-year-old established patient presented with severe throat pain that ...
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Reader Question:
Injury Change Warrants Second E/M
Question: An established patient with a history of left knee injuries reported to o...
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Reader Question:
Contact Your WC Payers Before Billing ICD-10
Question: I have heard I won’t use ICD-10 for workers’ compensation rel...
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You Be the Coder:
What Qualifies as ER POS?
Question: My physician was performing rounds at the hospital. He got a page that an...
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E/M Coding & Reimbursement Alert - 2015; Volume 3, Number 11
ICD-10:
Check 5 Key Diagnosis Code Changes To Perfect Your ICD-10 Claims
Hint: Skip the V codes. Oct. 1, 2015 has come and gone, and you have started usi...
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ICD-10 Spotlight:
Primary Care: Pinpoint Infectious vs. Noninfectious Gastroenteritis
The tests ordered can help guide you in the right direction. When your provider docume...
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ICD-10:
Revisit the ICD-10 Manual to Make Your Job Easier
Just because the book is thicker, doesn’t mean it is harder to use. Flipping th...
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ICD-10:
Review the Changes to Your Most Common Diagnoses
Make sure your provider’s documentation will lead you to the right code. Hopeful...
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Reader Question:
Don't Count CMS Software a Pass
Question: I have heard that Medicare has created free billing software that will le...
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Reader Question:
Avoid ICD-9 and ICD-10 on 1 CMS-1500 Form
Question: Our physician admitted a patient in September and didn’t discharge ...
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Reader Question:
Not Enough Documentation? Turn to 'Unspecified'
Question: If I find that a common ICD-9 code that I use doesn’t have a direct...
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You Be the Coder:
Coding 'Rule Out' Diagnoses
Question: My ED physician saw a patient for anterior wall chest pain. After he chec...
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E/M Coding & Reimbursement Alert - 2015; Volume 3, Number 10
CPT® 2016:
Get the Scoop on 2 New Prolonged Services Codes You Can Use Next Year
You’ll now be able to report more than just physician time. ‘Tis the seas...
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Reimbursement News:
Look Beyond Code Changes to Billing and Policy Updates
CMS pulls back on some proposed changes. With ICD-10 and CPT® code changes on the...
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ICD-10:
Look Beyond Oct. 1, 2015 in Your ICD-10 Training Plan
Focus on provider + coder cooperation to ensure success. The implementation date for ...
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ICD-10:
Amidst Anxiety Over Implementation, Focus on the Positives ICD-10 Will Bring
Combat ICD-10 stress with expert advice. Stress levels in your office — includin...
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Reader Question:
Learn 2 New POS Codes for 2016
Question: I heard a rumor that we’ll have new place of service codes for hosp...
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Reader Question:
Try 25 for E/M + Urinalysis
Question: Our practice performs urinalysis (81003) for some patients and we are hav...
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Reader Question:
Don't Assume ICU Means Critical Care
Question: My physician often rounds on patients in the intensive care unit (ICU). H...
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You Be the Coder:
I&D + E/M = 2 Codes
Question: Our physician reviewed a 56-year-old male patient with complaints of pain...
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E/M Coding & Reimbursement Alert - 2015; Volume 3, Number 9
Consultations:
Clear Up Consultation Coding Conundrums, Regardless of the Payer
Not all payers follow Medicare rules. For the past several years, you haven’t be...
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Billing:
Identify 'New Problem' Before Billing NPP Services
For established problems, consider billing incident-to the physician. If your practice...
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ICD-10:
Dig Into the Details of CMS's ICD-10 Announcement
Watch out: Other payers may not have a grace period. If you are confused by the July 6...
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Reader Questions:
Stop Submitting Opt-Out Authorization Every Year
Question: Our practice has chosen to opt out of Medicare. I heard that there’...
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Reader Questions:
Separately Report Counseling That Prompts Vaccination
Question: An established 19-year-old patient reported to our family physician for c...
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Reader Questions:
Obey the 60-day Max for Locum Tenens
Question: We will employ a substitute physician to fill in for one of our physician...
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You Be the Coder:
Flu Shot + E/M
Question: When patients come in for a flu shot, our nurse sees the patient first. She do...
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E/M Coding & Reimbursement Alert - 2015; Volume 3, Number 8
Primary Care E/M:
Tackle Camp, School, and Sports Physical Challenges with Preventive Medicine Codes -- Sometimes
Consider collecting from the patient when you can’t bill the payer. Summer and e...
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ICD-10:
Focus Your ED ICD-10 Prep on These Top-9 Codes, Part 2
Get to know five more common ED diagnoses and their ICD-10 updates. According to the l...
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ICD-10 News You Can Use
There is good news on the diagnosis coding front. According to a recent CMS guidance doc...
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Unlock Observation Pay By Getting to Know the Timing Rules
Check the clock before you code. With multiple code sets for different types of observ...
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Reader Question:
Compare Treatment and Transfer of Care
Question: Is it true that I cannot bill a consultation if the consulting physician takes...
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You Be the Coder:
Same-Day E/M and Critical Care
Question: We had a patient with a history of angina report to the emergency departm...
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E/M Coding & Reimbursement Alert - 2015; Volume 3, Number 7
E/M Compliance:
Ensure Medical Necessity Before Leveling Your E/M Services
Key: MDM and medical necessity are not the same. If you are reporting high level E/M c...
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ICD-10:
Focus Your ED ICD-10 Prep on These Top-9 Codes, Part 1
Set yourself up for diagnosis success this fall. Without the correct diagnosis codes t...
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Self Audits:
Analyze E/M Trends to See Where Your Practice Fits
Comparing your coding to the curve can focus your provider education. These days, it i...
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Reader Questions:
Check the Dates Before Adding 57
Question: A patient had an office visit (99213) with a 185 diagnosis on Feb. 17. The nex...
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Reader Questions:
Skipping PFSH Can Cost You
Question: I have a claim in front of me that is giving me pause because I cannot decide ...
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You Be the Coder:
Specialty Designation Matters in New vs. Established
Question:If a patient is referred to our practice for otitis media in 2014 from Dr. Smit...
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E/M Coding & Reimbursement Alert - 2015; Volume 3, Number 6
Emergency Department E/M:
Don't Let Lack of Official Guidelines Waylay Your Facility Coding Compliance
Keep medical necessity at the forefront of your facility’s guidelines. Because C...
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ICD-10:
Get Specific with Allergic Rhinitis Diagnoses This Fall
Cause will affect your coding. ‘Tis the season for allergies, which means your p...
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Specialty Focus - Psychiatry:
Test Your E/M vs. Psych Eval Coding Know-How with 3 FAQs
Don’t interchange E/M and 90792. If you code for a practice that provides mental...
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Office Security:
Avoid PHI Breaches With Mobile Technology
Secure passwords are just the beginning. Chances are good that at least one provider i...
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Reader Questions:
Think 99395-99397 for a Periodic E/M
Question: A patient presents for her yearly examination, and the ob-gyn decides to ...
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Reader Questions:
Point Out Mandated Services With 32
Question: A 40-year-old male came into our office with a work-related back injury. ...
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You Be the Coder:
Screening Colonoscopy H&P + Problem-Oriented Service
Question: A high-risk patient came in for a screening colonoscopy to our gastroente...
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E/M Coding & Reimbursement Alert - 2015; Volume 3, Number 5
Inpatient E/M:
5 Steps Walk You Through Top-Notch Inpatient Consultation Coding
Know when to apply modifier AI for proper payment. When your physician provides consul...
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News You Can Use:
Stop Worrying About Double-Digit Pay Cuts
Move forward with ICD-10 plans for this fall, too. Things looked bleak as April ...
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Payer Pointers:
Get the Scoop on E/M Myths Direct From NGS
MDM and face-to-face requirements fall in the top-six questions. Whether your practice...
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Reader Questions:
Don't Rely on 'Other' ICD-10 Codes
Question: Though there are many crosswalks between ICD-9 to ICD-10, there are many ...
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You Be the Coder:
Unravel Intensive and Critical Codes for Neonate on Same Day
Question: My doctor saw a neonate early in the morning. Later that day her conditio...
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E/M Coding & Reimbursement Alert - 2015; Volume 3, Number 4
Case Study:
Improve Your Prolonged Service Coding by Reviewing 3 Coding Examples
Precise reasons in the note for extra time spent on a service are key to getting pa...
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ICD-10:
Be Ready for 2 GERD K Codes in October
Rely on the note to get information you need to choose either K21.0 or K21.9.Rely on the...
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Emergency Codes:
Report More Than 1 ED E/M Code to Pay Multiple Professionals
Don’t try to get paid for a nurse’s work in the ED when the patient doesn&rs...
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CPT® 2015:
Adopt New Advance Care Codes for End of Life Discussions
CMS isn’t paying for these services this year, but maybe your payer has a payment ...
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Reader Questions:
Ask Your Payer if They Use the 4 x 4 Rule
Question: I have heard of the 4 x 4 rule, but I don’t understand what that really ...
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Reader Question:
Save 99318 for Annual Assessments
Question:Our physician met a patient in a nursing facility in March and then saw the pat...
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Reader Question:
Don't Report a 99499 Without an E/M
Question: Can I use 99499 to report writing a prescription? Rhode Island Subscriber ...
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Reader Question:
Think Again When Reporting Same Date Admission and 99217
Question: A 69-year-old male patient came into our office this week with a mild acu...
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Reader Question:
Couple the HPV Vaccine with 99402
Question: An established patient came into our ob-gyn office wanting to talk about ...
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Reader Question:
Check for Another F2F in Past 3 Years
Question: We’ve been getting a denial for new patient code 99204. The only se...
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You Be the Coder:
Prepare for Denial When 2 Physicians Claim Consult on Same Day
Question: We are a large group with all the physicians billing under the same tax ID. On...
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E/M Coding & Reimbursement Alert - 2015; Volume 3, Number 3
Case Study:
3 Scenarios Help Refine Your Smoking Cessation Coding
Consider using G0436 or G0437 when making your coding decision. Coding smoking and tob...
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ICD-10:
Breathe Easy: Fourth Digit of Emphysema Codes Provides More Specificity
Two ICD-9 emphysema codes have a direct match to ICD-10 codes. If your providers perfo...
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Preventive Care:
Separate Problem-Oriented From Preventive Visit
You can report a problem with preventive but you need to support it in documentation. ...
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Quick Quiz:
Push Yourself to Answer 3 E/M Questions
Test and grade yourself to see if you need to take a refresher course. Many topics fal...
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Quick Quiz Answers:
Grade Yourself with Our Answers
Test and grade yourself to see if you need to take a refresher course. Answer 1: CMS n...
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Reader Question:
Watch Your 99218-99220 Observation Coding
Question: How should I code for a 55-year-old patient with mild chronic bronchitis ...
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Reader Question:
Make Use of Specific Codes for Home Visits
Question: We have a patient who had been in the neonatal intensive care unit since ...
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Reader Question:
Look to April 1 for Another CF Reduction
Question: Has the new conversion factor been updated since it was released in error...
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Reader Question:
Link an FBR to an E/M
Question: A mother brings her child into the office complaining that the child&rsqu...
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You Be the Coder:
Meet the Challenge of More Than One Problem Per Day
Question: I work in a practice that has multiple specialties such as orthopedic, ps...
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E/M Coding & Reimbursement Alert - 2015; Volume 3, Number 2
Key Elements:
Differentiate 99213, 99214 to Get the Pay That You Deserve
Knowing what to look for in documentation is the key to deciding outpatient visit leveli...
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ICD-10:
Look Forward to Diabetes Coding Being More Specific
Instead of both types of diabetes having the same base number, they’ll each have t...
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Chiropractic Spotlight:
Overcome the Challenge of E/M Coding with CMT Services
One call to your payer may be your ticket to bringing in chiropractic E/M payments. So...
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Reader Question:
Try 99455 If No Other Plan Pays
Question: What code should I use to submit a claim for a disability exam that our p...
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Reader Question:
Choose 99211 When an NPP Performs a Service
Question: A pediatrician in my practice ordered a mother to return with her child f...
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Reader Question:
Code Interoperative Consult as Inpatient
Question: Doctor A from our office was asked to provide an interoperative consultat...
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Reader Question:
Apply 99354 When Over Threshold
Question: Our doctor saw a new 10-year-old patient who was recently diagnosed with ...
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You Be the Coder:
Coding a Team Conference With Family Present
Question: A mid-level provider (MLP) in our office met with a patient’s family mem...
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E/M Coding & Reimbursement Alert - 2015; Volume 3, Number 1
Key Elements:
Secure an MDM for an Accurate E/M Level
Take time to break down the complexity of a diagnosis to get proper reimbursements. Wi...
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ICD-10:
Preview Hypertension Coding to Hit the Ground Running
The organ-related categories with ICD-10 should look familiar. There’s less than...
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Key Elements:
Practice the Marshfield System for Figuring MDM
Rely on the records to make choices for each MDM component. Figuring out the medica...
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Critical Care:
Don't Overlook Same-Day Critical Care and E/M
Errors in notes can cost you one service. If you’re coding for both an E/M visit...
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Reader Question:
Rely On 99462 for Subsequent Care of Newborn
Question: One of our pediatric physicians saw a newborn at the hospital with no med...
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Reader Question:
Add Online Consults in Claim
Question: A doctor securely emailed patient information to another physician for he...
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You Be the Coder:
Rely on Note for Reason for Partial History
Question: When we have an established patient that comes into our office that needs...
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Available Years:
2015
2014
2013