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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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