E/M Coding & Reimbursement Alert
CPT® 2018:
Get The Scoop On These New BHI and Behavioral Healthcare Management Codes
Remember: New CPT® code 99493 will replace HCPCS option G0503. For January 1, 2018, CPT®... Read more
Get The Scoop On These New BHI and Behavioral Healthcare Management Codes
Remember: New CPT® code 99493 will replace HCPCS option G0503. For January 1, 2018, CPT®... Read more
Modifiers:
UHC Now Mandates Appending Modifier SA on NPP E/M Claims
Not all payers follow this particular policy, so double-check with your individual payers.... Read more
UHC Now Mandates Appending Modifier SA on NPP E/M Claims
Not all payers follow this particular policy, so double-check with your individual payers.... Read more
Case Study:
Analyze This Scenario to Hone Your ACP Expertise For Cleaner Claims
Hint: Don't forget modifier 33. Test your advance care planning (ACP) coding skills with ... Read more
Analyze This Scenario to Hone Your ACP Expertise For Cleaner Claims
Hint: Don't forget modifier 33. Test your advance care planning (ACP) coding skills with ... Read more
Reader Question:
Think You Can Never Report Modifiers 24 and 25 Together? Think Again
Question: Can you ever report modifiers 24 and 25 on the same claim? Hawaii Subscriber A... Read more
Think You Can Never Report Modifiers 24 and 25 Together? Think Again
Question: Can you ever report modifiers 24 and 25 on the same claim? Hawaii Subscriber A... Read more
Reader Question:
Look to Critical Care Codes for this Scenario
Question: The patient reported to the emergency department (ED) in respiratory distress. H... Read more
Look to Critical Care Codes for this Scenario
Question: The patient reported to the emergency department (ED) in respiratory distress. H... Read more
You Be the Coder:
Lesson Learned: Reporting Preventive Service With Problem-Oriented E/M
Question: The physician saw a 39-year-old established male patient for an annual checkup. ... Read more
Lesson Learned: Reporting Preventive Service With Problem-Oriented E/M
Question: The physician saw a 39-year-old established male patient for an annual checkup. ... Read more
CPT® 2018:
Get the Scoop on These New CPT® 2018 E/M Codes
Don't miss: CPT® 2018 to delete anticoagulant codes 99363 and 99364. From behavioral hea... Read more
Get the Scoop on These New CPT® 2018 E/M Codes
Don't miss: CPT® 2018 to delete anticoagulant codes 99363 and 99364. From behavioral hea... Read more
TCM:
Get Your TCM Coding Right Every Time With These Handy Tips
If the patient dies before the 30-day TCM period elapses, don't report 99495 and 99496. E... Read more
Get Your TCM Coding Right Every Time With These Handy Tips
If the patient dies before the 30-day TCM period elapses, don't report 99495 and 99496. E... Read more
Coding Quiz:
When Should You Append Modifier 24 to the E/M Service? Find Out
Remember: Scheduled office visit doesn't rule out modifier 24. The physician provides an ... Read more
When Should You Append Modifier 24 to the E/M Service? Find Out
Remember: Scheduled office visit doesn't rule out modifier 24. The physician provides an ... Read more
Reader Question:
Correctly Handle an Injection Due to E/M Encounter
Question: The physician saw a 24-year-old new female patient for complaints of high f... Read more
Correctly Handle an Injection Due to E/M Encounter
Question: The physician saw a 24-year-old new female patient for complaints of high f... Read more
Reader Question:
Keep These G Modifiers in Mind for ABNs
Question: What are the G modifiers we may use on our services that need ABN claims? ... Read more
Keep These G Modifiers in Mind for ABNs
Question: What are the G modifiers we may use on our services that need ABN claims? ... Read more
Reader Question:
Determine Correct Modifier for LT Services
Question: One of our physicians, Dr. Adams, is going on a cruise this summer. Dr. Adams ha... Read more
Determine Correct Modifier for LT Services
Question: One of our physicians, Dr. Adams, is going on a cruise this summer. Dr. Adams ha... Read more
You Be the Coder:
Get to Know 99283 for E/M ED Claims
Question: The patient reported to the ED in the morning for a fever and nausea and vo... Read more
Get to Know 99283 for E/M ED Claims
Question: The patient reported to the ED in the morning for a fever and nausea and vo... Read more
TCM:
Answer 7 Questions to Clarify How You Report TCM Codes
Medication reconciliation and management must occur no later than date of face-to-face vis... Read more
Answer 7 Questions to Clarify How You Report TCM Codes
Medication reconciliation and management must occur no later than date of face-to-face vis... Read more
Modifier 25:
Pennsylvania's Independence BCBS Updates Modifier 25 Policy, Reduces Reimbursement
Remember: Minor procedures have a zero-day or 10-day post-op period. If your practice bil... Read more
Pennsylvania's Independence BCBS Updates Modifier 25 Policy, Reduces Reimbursement
Remember: Minor procedures have a zero-day or 10-day post-op period. If your practice bil... Read more
Reader Question:
Know When to Append Modifier 25
Question: If the physician performs a colonoscopy (45380) on the same day as an initi... Read more
Know When to Append Modifier 25
Question: If the physician performs a colonoscopy (45380) on the same day as an initi... Read more
Reader Question:
Avoid Reporting Prolonged E/M Services in ED
Question: Can we code for prolonged E/M services in the ED? Florida Subscriber Answ... Read more
Avoid Reporting Prolonged E/M Services in ED
Question: Can we code for prolonged E/M services in the ED? Florida Subscriber Answ... Read more
Reader Question:
Discover Which Elements are Needed for HPI
Question: What elements should we look for when selecting the HPI level? Nebraska Su... Read more
Discover Which Elements are Needed for HPI
Question: What elements should we look for when selecting the HPI level? Nebraska Su... Read more
Reader Question:
Decipher Modifier Indicator of 1 in CCI Edits
Question: I was looking up CCI edits for 99221 and 99212, and I saw the edits have a ... Read more
Decipher Modifier Indicator of 1 in CCI Edits
Question: I was looking up CCI edits for 99221 and 99212, and I saw the edits have a ... Read more
You Be the Coder:
Look to 99406 and 99407 for Smoking and Tobacco-Use Cessation Counseling
Question: If our physician performs smoking and tobacco-use cessation counseling, whi... Read more
Look to 99406 and 99407 for Smoking and Tobacco-Use Cessation Counseling
Question: If our physician performs smoking and tobacco-use cessation counseling, whi... Read more
Medicare Physician Fee Schedule:
2018 Proposed MPFS Suggests Revising 1995 and 1997 E/M Documentation Guidelines
Take note: CMS opens comment period until Sept. 1. CMS's recently released 2018 proposed ... Read more
2018 Proposed MPFS Suggests Revising 1995 and 1997 E/M Documentation Guidelines
Take note: CMS opens comment period until Sept. 1. CMS's recently released 2018 proposed ... Read more
News You Can Use:
NGS Reverses Original Exam Policy Change Decision
Planned change to EPF and detailed exams no longer considered mandatory. The MAC National... Read more
NGS Reverses Original Exam Policy Change Decision
Planned change to EPF and detailed exams no longer considered mandatory. The MAC National... Read more
ACP:
Refine Your ACP Coding Skills With These FAQs
Hint: There are no POS limitations for ACP services. Scratching your head over advance ca... Read more
Refine Your ACP Coding Skills With These FAQs
Hint: There are no POS limitations for ACP services. Scratching your head over advance ca... Read more
Reader Question:
Investigate Whether to Bill for 2 ED E/M Encounters
Question: A patient visits the ED in the morning for a fever, nausea, and vomiting, a... Read more
Investigate Whether to Bill for 2 ED E/M Encounters
Question: A patient visits the ED in the morning for a fever, nausea, and vomiting, a... Read more
Reader Question:
Avoid Reporting Both 99385 and 99402
Question: The physician saw a 21-year-old female patient for a general adult exam and... Read more
Avoid Reporting Both 99385 and 99402
Question: The physician saw a 21-year-old female patient for a general adult exam and... Read more
Reader Question:
Follow This Advice for ABNs
Question: A 32-year-old established patient visited our practice for an ob-gyn physic... Read more
Follow This Advice for ABNs
Question: A 32-year-old established patient visited our practice for an ob-gyn physic... Read more
You Be the Coder:
Choose the Right Code for This Office Visit
Question: The physician in an independent pediatric office has a patient with irregul... Read more
Choose the Right Code for This Office Visit
Question: The physician in an independent pediatric office has a patient with irregul... Read more
ACP:
3 Answers Clear Up Your Advance Care Planning Coding Confusion
Experts share what to include in 99497 and +99498 documentation. Navigating the time and ... Read more
3 Answers Clear Up Your Advance Care Planning Coding Confusion
Experts share what to include in 99497 and +99498 documentation. Navigating the time and ... Read more
Modifiers:
Go Beyond Just Documentation to Master Modifier 57
Hint: Always communicate with your payers. Not sure whether you are appropriately appendi... Read more
Go Beyond Just Documentation to Master Modifier 57
Hint: Always communicate with your payers. Not sure whether you are appropriately appendi... Read more
Compliance:
Receive a 99215 Denial? Expert Advice Will Show You What You Did Wrong
Hint: Always check the medical decision-making. Unfortunately, you may be one of the rank... Read more
Receive a 99215 Denial? Expert Advice Will Show You What You Did Wrong
Hint: Always check the medical decision-making. Unfortunately, you may be one of the rank... Read more
Reader Question:
ED Codes Don't Apply in the Office
Question: Our physician saw a patient in his office for an emergency. Can I use the e... Read more
ED Codes Don't Apply in the Office
Question: Our physician saw a patient in his office for an emergency. Can I use the e... Read more
Reader Question:
Count Removed Organ Towards ROS
Question: If the physician examines a patient who has had an organ removed, cany... Read more
Count Removed Organ Towards ROS
Question: If the physician examines a patient who has had an organ removed, cany... Read more
Reader Question:
Find Out When to Append Modifier 24
Question: A patient developed a post-op infection during the global period and return... Read more
Find Out When to Append Modifier 24
Question: A patient developed a post-op infection during the global period and return... Read more
You Be the Coder:
See What ICD-10 Codes to Report With 99497 and +99498
Question: What ICD-10 codes can I report with 99497 and +99498? I’ve heard that... Read more
See What ICD-10 Codes to Report With 99497 and +99498
Question: What ICD-10 codes can I report with 99497 and +99498? I’ve heard that... Read more
NGS News:
55 Percent of 99215 Claims Incorrect, NGS Review Reveals
Hint: Make sure you submit complete documentation for your claims. Don’t miss what ... Read more
55 Percent of 99215 Claims Incorrect, NGS Review Reveals
Hint: Make sure you submit complete documentation for your claims. Don’t miss what ... Read more
ACP:
3 Tips Help Hone Your Advance Care Planning Skills
Hint: Always document specifics in advance directives. At the beginning of last year, Med... Read more
3 Tips Help Hone Your Advance Care Planning Skills
Hint: Always document specifics in advance directives. At the beginning of last year, Med... Read more
Modifiers:
Bust These Modifier 57 Myths to Boost Your Bottom Line
Pay attention to the global period. As a coder, you know how important modifiers are on y... Read more
Bust These Modifier 57 Myths to Boost Your Bottom Line
Pay attention to the global period. As a coder, you know how important modifiers are on y... Read more
Reader Question:
Use Time as Dominant Factor
Question: My physician saw a patient for arthritis. Although the patient has been to ... Read more
Use Time as Dominant Factor
Question: My physician saw a patient for arthritis. Although the patient has been to ... Read more
Reader Question:
Medical Necessity Key to Reporting 99212
Question: A patient came in for a flu shot. Can I report an office visit code (such a... Read more
Medical Necessity Key to Reporting 99212
Question: A patient came in for a flu shot. Can I report an office visit code (such a... Read more
You Be the Coder:
Puzzle Out Split/Shared Vs. Incident-To Visits
Question: Can you please explain the difference between a split/shared evaluation and... Read more
Puzzle Out Split/Shared Vs. Incident-To Visits
Question: Can you please explain the difference between a split/shared evaluation and... Read more
CCI:
Master the Nuts and Bolts of CCI Edits to Excel in Your E/M Coding
Prep for CCI with tips from our pros. CMS created the Correct Coding Initiative (CCI) edi... Read more
Master the Nuts and Bolts of CCI Edits to Excel in Your E/M Coding
Prep for CCI with tips from our pros. CMS created the Correct Coding Initiative (CCI) edi... Read more
Coding Quiz:
How do You Choose the Right Hospital Discharge Code? Find Out
Hint: Time is the deciding factor. It’s no secret that evaluation and management (E... Read more
How do You Choose the Right Hospital Discharge Code? Find Out
Hint: Time is the deciding factor. It’s no secret that evaluation and management (E... Read more
Coding Quiz Answers:
Align Your Answers With These E/M Coding Solutions
Hint: Study the telemedicine modifiers. Did you make an A+ on our coding quiz? Test your ... Read more
Align Your Answers With These E/M Coding Solutions
Hint: Study the telemedicine modifiers. Did you make an A+ on our coding quiz? Test your ... Read more
Reader Question:
Get New Health Risk Assessment Instrument Codes
Question: Can you tell me about code 99420? One of our physicians wants more informat... Read more
Get New Health Risk Assessment Instrument Codes
Question: Can you tell me about code 99420? One of our physicians wants more informat... Read more
Reader Question:
Correctly Report Tick Removal
Question: An established patient who has been experiencing pain and itching and notic... Read more
Correctly Report Tick Removal
Question: An established patient who has been experiencing pain and itching and notic... Read more
Reader Question:
Learn When to Bill E/M with 29530
Question: After evaluating an established patient’s sprain of the medial collat... Read more
Learn When to Bill E/M with 29530
Question: After evaluating an established patient’s sprain of the medial collat... Read more
Reader Question:
Decipher Complicated Coding Scenario
Question: A patient came into our office for a scheduled visit, and we sent him direc... Read more
Decipher Complicated Coding Scenario
Question: A patient came into our office for a scheduled visit, and we sent him direc... Read more
Reader Question:
Don't Use 99211 as Catchall Code
Question: How should I bill the administration of the second and third shot of Gardas... Read more
Don't Use 99211 as Catchall Code
Question: How should I bill the administration of the second and third shot of Gardas... Read more
You Be the Coder:
Understand Exam Levels for Other MACs
Question: Our office is located in New Jersey, and we see patients from Pennsylvania,... Read more
Understand Exam Levels for Other MACs
Question: Our office is located in New Jersey, and we see patients from Pennsylvania,... Read more
Policy Change:
Understand NGS Policy Update on Exam Levels
As of July 1, detailed exams will require 6-7 body areas or organ systems. Recently, the ... Read more
Understand NGS Policy Update on Exam Levels
As of July 1, detailed exams will require 6-7 body areas or organ systems. Recently, the ... Read more
99211:
Adhere to These Additional Rules for 99211 Success
Don’t mix up 99211 with 99212. Last month, we saw how you can ace your 99211 coding... Read more
Adhere to These Additional Rules for 99211 Success
Don’t mix up 99211 with 99212. Last month, we saw how you can ace your 99211 coding... Read more
Smoking Cessation:
Brush Up on ABCs of Smoking and Tobacco-Use Cessation Counseling
See what info our pro says physicians should include in 99406 and 99407 documentation. Sm... Read more
Brush Up on ABCs of Smoking and Tobacco-Use Cessation Counseling
See what info our pro says physicians should include in 99406 and 99407 documentation. Sm... Read more
Reader Question:
Master Telephone E/M Codes
Question: Can you explain when I could correctly report 99441-99443? Florida Subscri... Read more
Master Telephone E/M Codes
Question: Can you explain when I could correctly report 99441-99443? Florida Subscri... Read more
Reader Question:
Know When to Use Team Conference Code
Question: Could you give me some insight into 99366? Arizona Subscriber Answer:&nbs... Read more
Know When to Use Team Conference Code
Question: Could you give me some insight into 99366? Arizona Subscriber Answer:&nbs... Read more
You Be the Coder:
Receive Guidance on 99221 and 99238
Question: Can you bill 99221 and 99238 on the same day under any circumstances? For e... Read more
Receive Guidance on 99221 and 99238
Question: Can you bill 99221 and 99238 on the same day under any circumstances? For e... Read more
99211:
Follow These 3 Rules to Ace 99211
Here’s why you never report 99211 for a new patient. Whether you’ve been an e... Read more
Follow These 3 Rules to Ace 99211
Here’s why you never report 99211 for a new patient. Whether you’ve been an e... Read more
PFSH 101:
Hone Your PFSH Skills to Excel in History Coding
There are two kinds of PFSH — pertinent and complete. If you find it challenging to... Read more
Hone Your PFSH Skills to Excel in History Coding
There are two kinds of PFSH — pertinent and complete. If you find it challenging to... Read more
Ask The Pros:
Learn 6 Tips to Achieve PFSH Success
You should be familiar with your EHR/EMR system. You’ve seen how important it is to... Read more
Learn 6 Tips to Achieve PFSH Success
You should be familiar with your EHR/EMR system. You’ve seen how important it is to... Read more
Reader Question:
Learn How to Bill E/M 99212, +90833, and +90863
Question: Can you bill separately for these three services if the physician performs ... Read more
Learn How to Bill E/M 99212, +90833, and +90863
Question: Can you bill separately for these three services if the physician performs ... Read more
Reader Question:
Master 99288 for Emergency Services
Question: Can you tell me more about the requirements for using 99288? Florida Subsc... Read more
Master 99288 for Emergency Services
Question: Can you tell me more about the requirements for using 99288? Florida Subsc... Read more
You Be the Coder:
Reporting Anticoagulant Management Codes
Question: Can you explain the anticoagulant management codes to me? Are they billable... Read more
Reporting Anticoagulant Management Codes
Question: Can you explain the anticoagulant management codes to me? Are they billable... Read more
Telemedicine:
Always Ace Coding for Your E/M Telemedicine Services
Don’t forget POS code 02 on your telemedicine claims. With CPT® 2017, you&rsquo... Read more
Always Ace Coding for Your E/M Telemedicine Services
Don’t forget POS code 02 on your telemedicine claims. With CPT® 2017, you&rsquo... Read more
Modifiers:
Master 4 Rules for Proper Modifier 27 Use
Use modifier 27 in hospital outpatient settings only. Turn to Appendix A in the AMA 2017 ... Read more
Master 4 Rules for Proper Modifier 27 Use
Use modifier 27 in hospital outpatient settings only. Turn to Appendix A in the AMA 2017 ... Read more
Reader Question:
Master Neonatal Critical Care
Question: We have a low-level nursery and we get called to the hospital for standby b... Read more
Master Neonatal Critical Care
Question: We have a low-level nursery and we get called to the hospital for standby b... Read more
Reader Question:
Understand Inpatient Initial Care Codes
Question: Can you use inpatient initial care codes 99221-99223 more than once in the ... Read more
Understand Inpatient Initial Care Codes
Question: Can you use inpatient initial care codes 99221-99223 more than once in the ... Read more
Reader Question:
Discern Requirements for Preventive Care/Problem-Focused E/Ms
Question: Our providers perform many preventive care services like physicals and well... Read more
Discern Requirements for Preventive Care/Problem-Focused E/Ms
Question: Our providers perform many preventive care services like physicals and well... Read more
Reader Question:
Learn How Often to Update ROS
Question: How often must you update the review of systems [ROS] for a patient? With e... Read more
Learn How Often to Update ROS
Question: How often must you update the review of systems [ROS] for a patient? With e... Read more
Reader Question:
Choose 1995 VS. 1997 Guidelines Per Encounter
Question: I’ve heard that I can choose either the 1995 or the 1997 documentatio... Read more
Choose 1995 VS. 1997 Guidelines Per Encounter
Question: I’ve heard that I can choose either the 1995 or the 1997 documentatio... Read more
You Be the Coder:
Demystify Custodial Care Center Options
Question: The physician provided services to a new patient in a custodial care center... Read more
Demystify Custodial Care Center Options
Question: The physician provided services to a new patient in a custodial care center... Read more
ED Coding:
Master Do's and Don'ts of ED Coding
Don't assume only ED physicians can use 99281-99285. If you've ever wanted to learn what ... Read more
Master Do's and Don'ts of ED Coding
Don't assume only ED physicians can use 99281-99285. If you've ever wanted to learn what ... Read more
Add-On Codes:
Jumpstart Your Prolonged Services Coding Skills
Make sure your prolonged services pass the half-hour mark. Have you ever wondered about y... Read more
Jumpstart Your Prolonged Services Coding Skills
Make sure your prolonged services pass the half-hour mark. Have you ever wondered about y... Read more
Inside the E/M Code:
Tackle MDM & Medical Necessity With This Tutorial
Medical necessity is the over-reaching criteria for all services. Does trying to grasp th... Read more
Tackle MDM & Medical Necessity With This Tutorial
Medical necessity is the over-reaching criteria for all services. Does trying to grasp th... Read more
Reader Question:
Determine Correct Choice for Death Pronouncement
Question: We had a trauma patient come to our hospital. One of our providers saw the ... Read more
Determine Correct Choice for Death Pronouncement
Question: We had a trauma patient come to our hospital. One of our providers saw the ... Read more
Reader Question:
Brush Up On 92002 And 99204 Coding
Question: I work in an ophthalmologist’s office, and there is confusion about w... Read more
Brush Up On 92002 And 99204 Coding
Question: I work in an ophthalmologist’s office, and there is confusion about w... Read more
You Be the Coder:
Coding for the First Hour of Critical Care
Question: If the doctor meets the requirements for critical care billing and has spen... Read more
Coding for the First Hour of Critical Care
Question: If the doctor meets the requirements for critical care billing and has spen... Read more
Bust Locum Tenens Myths To Stay On Track
Hint: Never leave out modifier Q6 when you report a locum’s services. Imagine this ... Read more
Hint: Never leave out modifier Q6 when you report a locum’s services. Imagine this ... Read more
Use Our Handy Guide To Become A Pro At Consults And Referrals
Remember: In a consultation, the consulting physician’s opinion is crucial. Pullin... Read more
Remember: In a consultation, the consulting physician’s opinion is crucial. Pullin... Read more
Coding Quiz:
Hone Your E/M Coding Skills With 4 Quick Questions
Would you get an A+ on these evaluation and management (E/M) questions? Don't miss out on... Read more
Hone Your E/M Coding Skills With 4 Quick Questions
Would you get an A+ on these evaluation and management (E/M) questions? Don't miss out on... Read more
Reader Question:
Get New Vs. Established Patient Right Every Time
Question: I work in a family practice office, and we will be having a new physician j... Read more
Get New Vs. Established Patient Right Every Time
Question: I work in a family practice office, and we will be having a new physician j... Read more
Reader Question:
Master Modifier 25 By Identifying Separate E/M
Question: My cardiologist saw an inpatient for acute claudication/ischemia of the foo... Read more
Master Modifier 25 By Identifying Separate E/M
Question: My cardiologist saw an inpatient for acute claudication/ischemia of the foo... Read more
Reader Question:
Watch Out For Hemiplegic Migraines
Question: My physician recently diagnosed a patient with hemiplegic migraines, but I&... Read more
Watch Out For Hemiplegic Migraines
Question: My physician recently diagnosed a patient with hemiplegic migraines, but I&... Read more
Reader Question:
Navigate Coding For Workplace Annual Well Visits
Question: My physician performs annual well visits for the employees of a company at ... Read more
Navigate Coding For Workplace Annual Well Visits
Question: My physician performs annual well visits for the employees of a company at ... Read more
You Be the Coder:
Decode Social History For Newborns
Question: What would be considered an acceptable social history for a newborn? We are havi... Read more
Decode Social History For Newborns
Question: What would be considered an acceptable social history for a newborn? We are havi... Read more