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E/M Coding & Reimbursement Alert

News You Can Use:
Wait Continues on Office/Outpatient E/M Level Revisions
But documentation relief is on its way, says CMS. On Nov. 1., the Centers for Medicare an... Read more
Documentation:
Know These 3 Guidelines for On-Target Time Coding
Hint: you'll need more than provider comments for complete documentation. How many times ... Read more
Compliance:
Safeguard Your Critical Care Claims with Internal Audits
Take these steps to avoid MAC, RAC, and CERT scrutiny. Critical care services are current... Read more
Reader Question:
Know How to Make a Positive out of Negative ROS
Question: Can we count a “complete” ROS when the provider includes a statement such as... Read more
Reader Question:
Code This E/M Combo Correctly
Question: An established patient reports to the orthopedist reporting pain on her right si... Read more
You Be the Coder:
Let Documentation, Not Dx, Determine E/M Level
Question: Which code should we report for evaluation of a cough, runny nose, and fever? We... Read more
News You Can Use:
Can NPPs Bill Multiple Same-Day E/Ms? This MAC Says "Yes"
NGS to relax NPP E/M rules if specialties differ. The good news? In the spirit of Medicar... Read more
Guidelines:
Count on This System to Find MDM Level
Points system helps take guesswork out of complexity determination. As important as medic... Read more
Documentation:
Make Sure Medical Necessity Drives Documentation
And know when, how it differs from MDM. If thoughts of claim denials keep you awake at ni... Read more
Reader Question:
Mend This Medicaid Modifier Muddle
Question: We recently provided a preventive medicine E/M service to a 13-year-old patient ... Read more
Reader Question:
Keep Your Eye on the Clock in This Multiple Physician Scenario
Question: I recently coded a critical care encounter in which Dr. A spent 30 minutes with ... Read more
You Be the Coder:
Know When, and When Not, to Code for Screening Colonoscopy, E/M
Question: We reported 99213 as well as the colonoscopy screening code G0121, and we used m... Read more
Behavioral Health:
Consider These Codes for Behavioral Health, Collaborative Care
Clinical responsibilities key to successful integration. The introduction of three new be... Read more
Critical Care:
Know CMS Criteria to Solve Critical Care Conundrums
Study these scenarios to understand correct care levels. You know that if a patient recei... Read more
Guidelines:
Add up HPI Elements Correctly for Accurate E/M Assessment
Know if you can rule duration in or out. If you've been an E/M coder for any length of ti... Read more
Reader Question:
Find the Right Location for Pediatric Critical Care Codes
Question: Our ED physician saw a critically ill pediatric patient yesterday but has n... Read more
Reader Question:
Use This Modifier to Code E/M and Surgery Together
Question: A patient presents to the emergency room with nausea and severe lower-right abdo... Read more
You Be the Coder:
Apply Real Guidelines to Code Virtual Visits
Question: How do we document email exchanges between a patient or patient's guardian and o... Read more
News You Can Use:
Get Your First Look at the Proposed E/M Revisions for 2019
Is the long-awaited shake-up finally on its way? “This Administration has listened and ... Read more
Preventive Medicine:
Got Preventive Medicine Questions? We've Got Answers
Know how to document and report separately with this handy FAQ. We all know that preventi... Read more
Critical Care:
Take This Advice for Correct Critical Care Coding
Let these 3 scenarios sharpen your understanding of definitions, documentation. Criticall... Read more
Reader Question:
Report E/M at Your Peril with Normal Test Results
Question: A patient came to our office for a urodynamics CMG/voiding pressure study. She d... Read more
Reader Question:
Distance Yourself from This Modifier
Question: When telehealth services are provided from our practice office, should our pract... Read more
Reader Question:
Factor More Than Risk in Pre-Op E/M Level Determination
Question: We just performed a pre-operative visit for a COPD patient of ours who is gettin... Read more
You Be the Coder:
Distinguish Dx, Document Double E/Ms
Question: We are billing an office visit for attention deficit hyperactivity disorder (ADH... Read more
Guidelines:
Let These Add-ons Add Up to Accurate Prolonged Service Coding
Hint: different providers mean different documentation. When an E/M service goes longer t... Read more
Compliance:
Be Careful When You Code Concurrent Care
Definition, documentation keys to successful claims. One patient. Two separate E/M servic... Read more
Mythbusters:
Bust These Modifier Myths for Maximum Reimbursement
Global days key to modifier 24/25 decision. Because they look so similar, modifier 24 (Un... Read more
Reader Question:
Bill Screen, not E/M, in This Prostate Scenario
Question: Is there any way to get paid for an established office visit when a patient come... Read more
Reader Question:
Add up Negatives to Complete ROS Equation
Question: Can we count a “complete” ROS when the surgeon includes a statement such as ... Read more
Reader Question:
Know Your Histories When Evaluating E/M Choice
Question: When coding an E/M chart, how do we know where the “current” conditions/symp... Read more
Reader Question:
Code for E/M on Patient Return for CMG Results
Question: A patient came to our office for a urodynamics cystometrogram (CMG)/voiding pres... Read more
You Be the Coder:
Choose 1995 or 1997 Based on Exam, Encounter
Question: We have traditionally used the 1995 E/M guidelines when making our code selectio... Read more
Guidelines:
Solve These Subsequent Care Scenarios
Let our experts help you evaluate and manage service level determinations. When a provide... Read more
Modifiers:
Relate to This Modifier, Receive Unrelated Service Revenue
But understand global periods before you append. Modifier 24 (Unrelated evaluation and ma... Read more
Specialty Spotlight:
Primary Care: Get Physical with These Preventive E/M Codes
And fully integrate school, sports, or work physicals into your revenue stream. Providing... Read more
Reader Question:
Know These 3 Components for Preop Clearance Success
Question: I am writing for some guidance on Medical Decision Making (MDM) E/M coding for v... Read more
Reader Question:
Complete Your PFSH Understanding for Pertinent Documentation
Question: What are the two types of past medical, family, and social history (PFSH), and h... Read more
You Be the Coder:
Let Location Determine TCM Code Choice
Question: What types of discharge fall under the transitional care management codes? New ... Read more
Auditing:
Avoid Audit Agony with This Modifier Advice
RAC review sheds light on improper claims reported during global periods. Think you know ... Read more
Specialty Spotlight:
Gastroenterology: Ask These Questions, Produce Clean E/M Claims
Make sure these 3 factors don't attract a MAC's attention. Coding for time. Demonstrating... Read more
Mythbusters:
Take Time to Bust These 4 Prolonged Service Myths
Our experts help you sort fact from fiction surrounding these E/M add-ons. When complex p... Read more
Reader Question:
Pinpoint Place of Service in This ED E/M Scenario
Question: We saw a patient in the ED for a possible broken bone following a car accident. ... Read more
Reader Question:
Know Your History for Successful E/M Chart Coding
Question: When coding an E/M chart, how do we know where the "current" conditions/symptoms... Read more
You Be the Coder:
Think Threshold to Understand Typical Time
Question: As a new coder, I am still a little confused by the times listed in the descript... Read more
Mythbusters:
Bust These E/M Coding Myths Once and for All
Part B MAC experts offer the lowdown on these common misconceptions. Navigating evaluatio... Read more
Guidelines:
Know How and When to Apply the "Nurse's Code"
These 5 tips and a scenario will help you use 99211 correctly. It's a frequently used - a... Read more
Care Management:
Consider These Components, Manage Chronic, Complex Care Coding
Four easy-to-follow suggestions will keep your reporting on track. Having trouble keeping... Read more
Reader Question:
Document Necessity in This E/M-25 Encounter
Question: Our claim for an evaluation and management (E/M) service and a procedure was aud... Read more
Reader Question:
Use This Code for Different Day Discharge
Question: I have a question about obstetrical patients in observation status. If a patient... Read more
Reader Question:
Choose Code Carefully in This Post-Procedure Scenario
Question: A surgeon requested that our anesthesiologist evaluate a patient regarding posto... Read more
You Be the Coder:
Append These 2 Modifiers When Circumstances Allow
Question: Can you ever report modifiers 24 and 25 on the same claim? Idaho Subscriber An... Read more
E/M Guidelines:
Look Here to Find the Answers to Your System Review Questions
Let our experts take the mystery out of ROS documentation. Most coders are familiar with ... Read more
Documentation:
Recognize Referral, Consultation Differences, Add to Your Bottom Line
Hint: understand payer guidelines and provide clear documentation for both services. Most... Read more
Save This Consult Rules and Regs Reminder
Remember these 5 Rs the next time you code this service. Before your providers can get pa... Read more
Specialty Spotlight:
Emergency Department: Understand When 99285 Is Too Much or Not Enough
Level of care should be determined by elements and rise with time. "According to an Offic... Read more
Reader Question:
Bill This Counseling Visit Even When Patient Is Absent
Question: We have a mom that came in for a consult about her 5-year-old son, but he was no... Read more
Reader Question:
Code for Incident-To Service for Established Patient Only
Question: Can you report 99211 for new patients? Illinois Subscriber Answer: No, you can... Read more
You Be the Coder:
Know How This New Rule Changes Documentation Requirements
Question: Our providers complain about having to re-document the elements of E/M services ... Read more
Mythbusters:
Avoid HPI Pitfalls by Busting These Myths
Know what counts - and what doesn't - in E/M level calculations. If you get confused fact... Read more
Observation Coding:
View This FAQ, See Observation Coding Clearly
Time and language key to code choice. Two code sets. Different location requirements. Len... Read more
Specialty Spotlight:
Pediatrics: Learn These Definitions, Document Delivery and Beyond
Understand services, time, weight, and condition for newborn coding success. Experienced ... Read more
Reader Question:
Evaluate Global Days, Modify E/M Services Correctly
Question: A patient presents for an evaluation and management (E/M) visit two-weeks follow... Read more
Reader Question:
Decide the Best Way to Use This E/M-Specific Modifier
Question: When are you supposed to report modifier 57? Is it a modifier for evaluation and... Read more
Reader Question:
Document E/M Service With This Injection Encounter
Question: Encounter notes indicate that the provider performed a level-three evaluation an... Read more
You Be the Coder:
Code This Asthma Encounter and Breathe Easy
Question: Our provider just saw a patient who had recently been to a local hospital's emer... Read more
News You Can Use:
Increase in Conversion Factor Will Boost Your 2018 Bottom Line
But RVUs, CCM, and E/M guideline changes still on hold. Have you noticed a small rise in ... Read more
Coding Quiz Answers:
Check Your Answers to our Admissions E/M Quiz
How do your scenario solutions compare with our experts'? Think you aced last month's qui... Read more
Specialty Spotlight:
Pulmonology: Look to E/M Documentation for PAP Approvals
And document compliance with follow-up E/M. Positive airway pressure (PAP) devices can be... Read more
Reader Question:
Base ED E/M Code on Problem and Work, Not Final Dx
Question: A patient presents to the ED with chest pain. The patient receives a complex car... Read more
Reader Question:
Use This Bucket List to Decide Between Different PFSH
Question: Can you give me an example of pertinent PFSH versus complete PFSH? Florida Subs... Read more
Reader Question:
Implant Modifier 25 Into This E/M Scenario
Question: Our surgeon saw a patient in the office who was referred by another physician fo... Read more
You Be the Coder:
Choose Different E/M Codes for Psych Evals When Focus Changes
Question: When I looked through the kind of work that our psychiatrist does, he mostly doe... Read more
News You Can Use:
Ready for E/M Guidelines to Change? You'll Have to Wait a Little Longer
But telehealth expansion continues in the 2018 MPFS. It's a case of two steps forward, on... Read more
Coding Quiz:
Think You Know Admissions E/M Documentation?
Answer these questions and find out. Because it can involve different dates and different... Read more
Specialty Spotlight:
Ophthalmology & Optometry: Look to Documentation for the Right E/M, Eye Code Decision
Hint: Payer guidelines for diagnostic and treatment programs are key. No matter what your... Read more
Reader Question:
If You Work With APNs, Do This
Question: We have two house-call teams of APNs (advanced practice nurses) who go to patien... Read more
Reader Question:
Rely on 99291 for This Case
Question: The critical care unit called the emergency physician at 4 a.m. to see a patient... Read more
Reader Question:
Bust This Prolonged Care Services Myth
Question: Can you report prolonged services with any level of E/M code or just the highest... Read more
You Be the Coder:
New or Established? It's Not Simply About the Three-Year Rule
Question: What is the difference between a new and established patient when reporting eval... Read more
Available Years:  2018  2017  2016  2015  2014  2013  

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