E/M Coding & Reimbursement Alert
News You Can Use:
Know What the PFS Has in Store for You in 2020
CMS introduces PCM and revamps prolonged services coding. There's a lot to interest E/M c... Read more
Know What the PFS Has in Store for You in 2020
CMS introduces PCM and revamps prolonged services coding. There's a lot to interest E/M c... Read more
Observation Coding:
Review These Encounters for Worry-Free Observation Coding
Know how, when to apply the 8-hour rule. If you get confused using the observation codes,... Read more
Review These Encounters for Worry-Free Observation Coding
Know how, when to apply the 8-hour rule. If you get confused using the observation codes,... Read more
Specialty Spotlight:
Answer These 3 Questions, Quit Smoking Cessation Coding Errors for Good
Add these Medicare guidelines to your claims understanding. No matter if their patients w... Read more
Answer These 3 Questions, Quit Smoking Cessation Coding Errors for Good
Add these Medicare guidelines to your claims understanding. No matter if their patients w... Read more
Reader Question:
Read Between the Lines to Locate Hidden Complaints
Question: We know we can't report an E/M code without a chief complaint, but sometimes we ... Read more
Read Between the Lines to Locate Hidden Complaints
Question: We know we can't report an E/M code without a chief complaint, but sometimes we ... Read more
Reader Question:
Keep HPI, ROS Separate in E/M Calculations
Question: For an E/M visit, if the physician states ROS as noted in the patient's HPI, can... Read more
Keep HPI, ROS Separate in E/M Calculations
Question: For an E/M visit, if the physician states ROS as noted in the patient's HPI, can... Read more
Reader Question:
Follow This Guideline, Keep Test Results, E/M Separate
Question: Following allergy testing, the physician meets with the patient to go over the r... Read more
Follow This Guideline, Keep Test Results, E/M Separate
Question: Following allergy testing, the physician meets with the patient to go over the r... Read more
You Be the Coder:
Separate Some Same-Day E/M, ER Encounters
Question: If a patient was seen for an office visit (99214) first and then later on the sa... Read more
Separate Some Same-Day E/M, ER Encounters
Question: If a patient was seen for an office visit (99214) first and then later on the sa... Read more
News You Can Use:
Have You Heard the Good News? ED E/M RVUs Could Be on the Rise
Higher pay for 99281-99285 may be on the horizon. Emergency departments (EDs) around the ... Read more
Have You Heard the Good News? ED E/M RVUs Could Be on the Rise
Higher pay for 99281-99285 may be on the horizon. Emergency departments (EDs) around the ... Read more
Guidelines:
Take Your ED E/M Coding to the Next Level
Does your documentation justify those 99285s? You know that E/Ms, especially high-level E... Read more
Take Your ED E/M Coding to the Next Level
Does your documentation justify those 99285s? You know that E/Ms, especially high-level E... Read more
Telemedicine:
Comprehend the Virtual Check-In Codes With This FAQ
Get all the answers to your questions before you bill for your next patient call. Telepho... Read more
Comprehend the Virtual Check-In Codes With This FAQ
Get all the answers to your questions before you bill for your next patient call. Telepho... Read more
Reader Question:
Know Guidelines to Calculate HPI With Elements or Chronic Conditions
Question: When counting E/M history, can we use chronic medical conditions in place of ele... Read more
Know Guidelines to Calculate HPI With Elements or Chronic Conditions
Question: When counting E/M history, can we use chronic medical conditions in place of ele... Read more
Reader Question:
Document Necessity, Not Elements, When Levelling by Time
Question: If I am billing an E/M encounter by time, does documentation for the E/M element... Read more
Document Necessity, Not Elements, When Levelling by Time
Question: If I am billing an E/M encounter by time, does documentation for the E/M element... Read more
Reader Question:
Observe the Rules to Bill the Right Inpatient E/M
Question: Our pulmonologist admitted a patient to the hospital at 11:30 a.m. A different p... Read more
Observe the Rules to Bill the Right Inpatient E/M
Question: Our pulmonologist admitted a patient to the hospital at 11:30 a.m. A different p... Read more
You Be the Coder:
Examine Payer Policy in This Coding Conundrum
Question: We have a patient who is a pilot, and per Federal Aviation Administration (FAA) ... Read more
Examine Payer Policy in This Coding Conundrum
Question: We have a patient who is a pilot, and per Federal Aviation Administration (FAA) ... Read more
New You Can Use:
Evaluate and Manage These CPT® 2020 Revisions
Get ready to change the way you report online E/M, monitoring. Asynchronous online E/M se... Read more
Evaluate and Manage These CPT® 2020 Revisions
Get ready to change the way you report online E/M, monitoring. Asynchronous online E/M se... Read more
Prolonged Service:
Know How to Code for Prolonged Service Without Direct Patient Contact
Here's how to make 99358 work for you. Last month, we discussed how to report services wh... Read more
Know How to Code for Prolonged Service Without Direct Patient Contact
Here's how to make 99358 work for you. Last month, we discussed how to report services wh... Read more
Critical Care:
Got More Critical Care Questions? Here Are Four More Answers
Beware of guidelines, bundling, and time reporting. In E/M Coding Alert Volume 7 Number 7... Read more
Got More Critical Care Questions? Here Are Four More Answers
Beware of guidelines, bundling, and time reporting. In E/M Coding Alert Volume 7 Number 7... Read more
Reader Question:
Don't Schedule This Code for Late Patients
Question: A patient called and said she thought she had a detached retina, and we schedule... Read more
Don't Schedule This Code for Late Patients
Question: A patient called and said she thought she had a detached retina, and we schedule... Read more
Reader Question:
Identify This Same-Day Injection Service Separately
Question: Can I bill for an E/M visit for an allergy evaluation and an allergy injection o... Read more
Identify This Same-Day Injection Service Separately
Question: Can I bill for an E/M visit for an allergy evaluation and an allergy injection o... Read more
Reader Question:
Take the Time to Document Correctly
Question: I'm confused about coding E/M services by time. Do we have to document the exact... Read more
Take the Time to Document Correctly
Question: I'm confused about coding E/M services by time. Do we have to document the exact... Read more
You Be the Coder:
Get the Skinny on Substance Screening
Question: We saw a patient for a panic attack who revealed a cocaine addiction. The ED phy... Read more
Get the Skinny on Substance Screening
Question: We saw a patient for a panic attack who revealed a cocaine addiction. The ED phy... Read more
Guidelines:
Take Time to Code Your E/M Encounters
Use this Definitive Guide for Time-Based Coding. Time-based E/M coding has always been th... Read more
Take Time to Code Your E/M Encounters
Use this Definitive Guide for Time-Based Coding. Time-based E/M coding has always been th... Read more
Check These 4 Examples of Appropriate Time-Based Coding Notes
If you're just getting your feet wet with time-based E/M coding, check out these examples ... Read more
If you're just getting your feet wet with time-based E/M coding, check out these examples ... Read more
Prolonged Services:
Prolong Your Time-Based Coding Understanding
Location key to correct code choice. CPT® guidelines for reporting different kinds of pr... Read more
Prolong Your Time-Based Coding Understanding
Location key to correct code choice. CPT® guidelines for reporting different kinds of pr... Read more
Documentation:
Answer These Questions, Receive a ROS Refresher
Find the right level for all your ED E/M encounters. Maybe your review of systems (ROS) k... Read more
Answer These Questions, Receive a ROS Refresher
Find the right level for all your ED E/M encounters. Maybe your review of systems (ROS) k... Read more
Reader Question:
Think Global for Modifier Precision
Question: Our surgeon saw an established patient in the office to examine a third-deg... Read more
Think Global for Modifier Precision
Question: Our surgeon saw an established patient in the office to examine a third-deg... Read more
Reader Question:
Observe These Rules, Report Subsequent Care With Ease
Question: Our pulmonologist was called in to the hospital by the admitting doctor as ... Read more
Observe These Rules, Report Subsequent Care With Ease
Question: Our pulmonologist was called in to the hospital by the admitting doctor as ... Read more
Reader Question:
Know How to Determine Medical Necessity
Question: My practice has had a couple of claims denied. The payers said the services... Read more
Know How to Determine Medical Necessity
Question: My practice has had a couple of claims denied. The payers said the services... Read more
You Be the Coder:
Learn the Right Way to Report Prescription Refills
Question: Can you count a routine prescription refill as a moderate level of risk when det... Read more
Learn the Right Way to Report Prescription Refills
Question: Can you count a routine prescription refill as a moderate level of risk when det... Read more
Practice Management:
Take These 3 Steps, Minimize No-Show Patients
Hint: don't fall for the 99199 myth. When patients fail to show for a consult or preventi... Read more
Take These 3 Steps, Minimize No-Show Patients
Hint: don't fall for the 99199 myth. When patients fail to show for a consult or preventi... Read more
Documentation:
Use This Chart to Make HPI Elements Count
And take this expert advice to avoid repeating history mistakes. You know how the history... Read more
Use This Chart to Make HPI Elements Count
And take this expert advice to avoid repeating history mistakes. You know how the history... Read more
Specialty Spotlight:
Solve These 4 Neonatal Transfer of Care Scenarios, Keep Your Claims Clean
Know the codes to use and who can use them. Care for a child immediately after birth can ... Read more
Solve These 4 Neonatal Transfer of Care Scenarios, Keep Your Claims Clean
Know the codes to use and who can use them. Care for a child immediately after birth can ... Read more
Reader Question:
Question Payer Policy in This E/M Bundle
Question: A carrier is denying a claim for a 99213 with an 81000 saying that the urinalysi... Read more
Question Payer Policy in This E/M Bundle
Question: A carrier is denying a claim for a 99213 with an 81000 saying that the urinalysi... Read more
Reader Question:
Use This Documentation for Medication Checkup E/M
Question: Our provider saw a patient with GERD and started her on esomeprazole. The patien... Read more
Use This Documentation for Medication Checkup E/M
Question: Our provider saw a patient with GERD and started her on esomeprazole. The patien... Read more
You Be the Coder:
Mend This Multiple Modifier Muddle
Question: We have a small practice in a designated health professional shortage area (HPSA... Read more
Mend This Multiple Modifier Muddle
Question: We have a small practice in a designated health professional shortage area (HPSA... Read more
News You Can Use:
Prepare for Big CPT® E/M Changes Heading Your Way
Codes, times, guidelines all poised for overhaul. For some time now, the coding community... Read more
Prepare for Big CPT® E/M Changes Heading Your Way
Codes, times, guidelines all poised for overhaul. For some time now, the coding community... Read more
Critical Care:
Got Critical Care Questions? We've Got Answers.
Know how to report 99291 and +99292 correctly in or out of the ED. You may think you know... Read more
Got Critical Care Questions? We've Got Answers.
Know how to report 99291 and +99292 correctly in or out of the ED. You may think you know... Read more
E/M Auditing:
Use CBR Data Effectively With These 3 Hints
These MAC reports will help you keep your E/M coding in line. Are you paying attention to... Read more
Use CBR Data Effectively With These 3 Hints
These MAC reports will help you keep your E/M coding in line. Are you paying attention to... Read more
Reader Question:
Determine New vs. Established by Service, Not E/M
Question: A patient came in for an E/M service on February 19, 2019. The patient previousl... Read more
Determine New vs. Established by Service, Not E/M
Question: A patient came in for an E/M service on February 19, 2019. The patient previousl... Read more
Reader Question:
Locate This Code for Correct Consult Choice
Question: Our surgeon saw a non-Medicare patient in the office for a consultation, and the... Read more
Locate This Code for Correct Consult Choice
Question: Our surgeon saw a non-Medicare patient in the office for a consultation, and the... Read more
Reader Question:
Review the Answer to This ROS Recording Question
Question: There is a debate in our office about who can record an ROS. Can you help us? M... Read more
Review the Answer to This ROS Recording Question
Question: There is a debate in our office about who can record an ROS. Can you help us? M... Read more
You Be the Coder:
Go Beyond E/M to Capture This FBR, Epistaxis Service
Question: Our provider just saw an established patient with a nosebleed. The patient's mot... Read more
Go Beyond E/M to Capture This FBR, Epistaxis Service
Question: Our provider just saw an established patient with a nosebleed. The patient's mot... Read more
Guidelines:
Take These 3 Tips to Get Time on Your Side
Learn how to employ the “counseling exception” correctly. No matter what your special... Read more
Take These 3 Tips to Get Time on Your Side
Learn how to employ the “counseling exception” correctly. No matter what your special... Read more
Transitional Care:
Understand These Codes, Document Transitional Care With Ease
Know these five simple rules to manage 99495 and 99496 effectively. They may have an over... Read more
Understand These Codes, Document Transitional Care With Ease
Know these five simple rules to manage 99495 and 99496 effectively. They may have an over... Read more
Specialty Spotlight:
Know When, When Not to Use E/M Codes for Pre-Colonoscopy Screenings
Hint: patient dx key to reporting 99201-99215 in addition to colonoscopy code. One of the... Read more
Know When, When Not to Use E/M Codes for Pre-Colonoscopy Screenings
Hint: patient dx key to reporting 99201-99215 in addition to colonoscopy code. One of the... Read more
Reader Question:
Be Critical When Coding This ED Encounter
Question: A patient became unresponsive in the ED and the physician began critical care bu... Read more
Be Critical When Coding This ED Encounter
Question: A patient became unresponsive in the ED and the physician began critical care bu... Read more
Reader Question:
Look to Management Options, Resolve This Risk-Level Riddle
Question: I'm trying to determine the level of risk in the following encounter: a patient ... Read more
Look to Management Options, Resolve This Risk-Level Riddle
Question: I'm trying to determine the level of risk in the following encounter: a patient ... Read more
You Be the Coder:
Keep Track of Time, Report Observation Care Correctly
Question: Since 99234-99236 require at least eight hours in observation, do we need to tra... Read more
Keep Track of Time, Report Observation Care Correctly
Question: Since 99234-99236 require at least eight hours in observation, do we need to tra... Read more
Documentation:
Test Your E/M Coding Savvy with These 3 Questions
Can you come up with all the right answers? E/M levelling is part science, part art. And ... Read more
Test Your E/M Coding Savvy with These 3 Questions
Can you come up with all the right answers? E/M levelling is part science, part art. And ... Read more
Preventive Medicine:
Prevent Payment Problems With This Preventive E/M Advice
Dx codes key to justifying same-day preventive and problem-oriented visits. What do you d... Read more
Prevent Payment Problems With This Preventive E/M Advice
Dx codes key to justifying same-day preventive and problem-oriented visits. What do you d... Read more
Practice Management:
Make Late Filings a Thing of the Past With These Timely Hints
Use these 3 proven tips to beat the 12-month rule. There's nothing more frustrating to a ... Read more
Make Late Filings a Thing of the Past With These Timely Hints
Use these 3 proven tips to beat the 12-month rule. There's nothing more frustrating to a ... Read more
Reader Question:
Bundle Vent Management in This Critical Care Scenario
Question: Our physician performed vent management on a critically ill patient. We reported... Read more
Bundle Vent Management in This Critical Care Scenario
Question: Our physician performed vent management on a critically ill patient. We reported... Read more
Reader Question:
Establish These 3 Rules for New Patient Determination
Question: Our practice was recently audited, and an established patient visit was marked a... Read more
Establish These 3 Rules for New Patient Determination
Question: Our practice was recently audited, and an established patient visit was marked a... Read more
Reader Question:
Don't Look for Easy Answers in the Specialty Vs. E/M Service Debate
Question: What criteria should eye care practices use when deciding between E/M codes and ... Read more
Don't Look for Easy Answers in the Specialty Vs. E/M Service Debate
Question: What criteria should eye care practices use when deciding between E/M codes and ... Read more
You Be the Coder:
Modify Your Understanding of Initial Hospital Care Codes
Question: Can you use inpatient initial care codes 99221-99223 more than once in the same ... Read more
Modify Your Understanding of Initial Hospital Care Codes
Question: Can you use inpatient initial care codes 99221-99223 more than once in the same ... Read more
Specialty Spotlight - Pulmonology:
Keep Your E/M Coding Audit Free
Hint: Look for the same patterns CMS is seeing. The latest focus for recovery audit contr... Read more
Keep Your E/M Coding Audit Free
Hint: Look for the same patterns CMS is seeing. The latest focus for recovery audit contr... Read more
Coding Quiz:
Can You Pass This Chronic Care Quiz?
Here's your chance to show off your mastery of the 2019 CPT® CCM changes. Did you have q... Read more
Can You Pass This Chronic Care Quiz?
Here's your chance to show off your mastery of the 2019 CPT® CCM changes. Did you have q... Read more
Telemedicine:
Make the Right Call With These New Telemedicine Codes
CCI edits, payer problems, create coding uncertainty. If you've hesitated to use the new ... Read more
Make the Right Call With These New Telemedicine Codes
CCI edits, payer problems, create coding uncertainty. If you've hesitated to use the new ... Read more
Coding Quiz Answers:
Check Your Answers to Our CCM Coding Quiz
Once you've answered the quiz questions, compare your answers with the ones provided below... Read more
Check Your Answers to Our CCM Coding Quiz
Once you've answered the quiz questions, compare your answers with the ones provided below... Read more
Reader Question:
Go Beyond MDM to Interpret E/M Level
Question: We recently took on a new patient who is deaf. The patient came with a family me... Read more
Go Beyond MDM to Interpret E/M Level
Question: We recently took on a new patient who is deaf. The patient came with a family me... Read more
Reader Question:
Note This Difference Between Consult Rules
Question: What is the difference between an office consultation and an inpatient consultat... Read more
Note This Difference Between Consult Rules
Question: What is the difference between an office consultation and an inpatient consultat... Read more
You Be the Coder:
Know This New Patient E/M Rule
Question: I have a new patient present with impacted cerumen removal. Since this pati... Read more
Know This New Patient E/M Rule
Question: I have a new patient present with impacted cerumen removal. Since this pati... Read more
Modifiers:
Think You Know Modifier 25? Find Out With This Comprehensive Guide
End the modifier muddle with the answers to these questions. You may think you know modif... Read more
Think You Know Modifier 25? Find Out With This Comprehensive Guide
End the modifier muddle with the answers to these questions. You may think you know modif... Read more
Coding Quiz:
Answer These Quiz Questions to Expand Your ROS Knowledge
And enhance your E/M coding skills with some expert ROS opinion. A review of systems (ROS... Read more
Answer These Quiz Questions to Expand Your ROS Knowledge
And enhance your E/M coding skills with some expert ROS opinion. A review of systems (ROS... Read more
Coding Quiz Answers:
Check Your Answers to Our ROS Coding Quiz
Once you've answered the quiz questions, compare your answers with the ones provided below... Read more
Check Your Answers to Our ROS Coding Quiz
Once you've answered the quiz questions, compare your answers with the ones provided below... Read more
Observation Care:
Heed This Advice for Clean, Compliant Observation Care Claims
CMS report points finger at insufficient documentation, incorrect coding. If you've ever ... Read more
Heed This Advice for Clean, Compliant Observation Care Claims
CMS report points finger at insufficient documentation, incorrect coding. If you've ever ... Read more
Reader Question:
Be Specific With Follow-Up Chief Complaints
Question: Our otolaryngologist lists the chief complaint (CC) for all follow-up visits usi... Read more
Be Specific With Follow-Up Chief Complaints
Question: Our otolaryngologist lists the chief complaint (CC) for all follow-up visits usi... Read more
Reader Question:
Take E/M Off the Table When Key Components Absent
Question: An established 66-year-old patient presented to our provider. She did not state ... Read more
Take E/M Off the Table When Key Components Absent
Question: An established 66-year-old patient presented to our provider. She did not state ... Read more
Reader Question:
Pick Initial Care Code Once When Multiple Providers Involved
Question: Can you use inpatient initial care codes 99221-99223 more than once in the same ... Read more
Pick Initial Care Code Once When Multiple Providers Involved
Question: Can you use inpatient initial care codes 99221-99223 more than once in the same ... Read more
You Be the Coder:
Get Critical With Bundled Critical Care Services
Question: I am new to coding. Can you help me understand what constitutes as critical care... Read more
Get Critical With Bundled Critical Care Services
Question: I am new to coding. Can you help me understand what constitutes as critical care... Read more
Specialty Spotlight:
Get Answers to Your ED E/M Questions with This FAQ
Throw out these two rules, but apply the one that really matters. You may think you... Read more
Get Answers to Your ED E/M Questions with This FAQ
Throw out these two rules, but apply the one that really matters. You may think you... Read more
Compliance:
Clarify Condition for Clean Concurrent Care Claims
Documentation key when multiple providers administer care. Concurrent care scenarios are ... Read more
Clarify Condition for Clean Concurrent Care Claims
Documentation key when multiple providers administer care. Concurrent care scenarios are ... Read more
Modifier Use:
Remember These 3 Facts, Bust This 1 Myth, for Accurate Modifier 24 Application
Hint: you'll need to know global surgical packages to bill for E/M as well. Bundling unre... Read more
Remember These 3 Facts, Bust This 1 Myth, for Accurate Modifier 24 Application
Hint: you'll need to know global surgical packages to bill for E/M as well. Bundling unre... Read more
Reader Question:
Let These Guidelines Drive NPP Virtual Visit Code Choice
Question: What's the best way to document email exchanges between a patient's guardian and... Read more
Let These Guidelines Drive NPP Virtual Visit Code Choice
Question: What's the best way to document email exchanges between a patient's guardian and... Read more
Reader Question:
Modify Your Understanding of E/M, X-Ray Reading
Question: We used to do X-rays in our practice, but we now send out for them. If the facil... Read more
Modify Your Understanding of E/M, X-Ray Reading
Question: We used to do X-rays in our practice, but we now send out for them. If the facil... Read more
You Be the Coder:
Know Provider, Choose Correct Prolonged Service Code
Question: We bill based on time pretty frequently, particularly when we see pediatric pati... Read more
Know Provider, Choose Correct Prolonged Service Code
Question: We bill based on time pretty frequently, particularly when we see pediatric pati... Read more
Guidelines:
Take These PFSH Tips, and Documentation Errors Will Be History
And know the 2019 Final Rule extends PFSH rules to CC, HPI You know that documenting a pa... Read more
Take These PFSH Tips, and Documentation Errors Will Be History
And know the 2019 Final Rule extends PFSH rules to CC, HPI You know that documenting a pa... Read more
Guidelines:
Go Beyond the 3-Year Rule to Assign Patient Status Accurately
New vs. established more complex than you think. If you think that the “three-year rule... Read more
Go Beyond the 3-Year Rule to Assign Patient Status Accurately
New vs. established more complex than you think. If you think that the “three-year rule... Read more
Documentation:
Pay Attention to Medicare Guidelines Before Documentation Sign Off
These 5 simple steps will help you avoid claims denials, compliance issues. Making sure t... Read more
Pay Attention to Medicare Guidelines Before Documentation Sign Off
These 5 simple steps will help you avoid claims denials, compliance issues. Making sure t... Read more
Reader Question:
Keep Time on Your Side with This E/M Documentation Tip
Question: We have a provider who sees a lot of pediatric patients with their parents. The ... Read more
Keep Time on Your Side with This E/M Documentation Tip
Question: We have a provider who sees a lot of pediatric patients with their parents. The ... Read more
Reader Question:
Extend Your HPI Knowledge to Assign E/M Levels Correctly
Question: One of our physician assistants believes that if she has an extended HPI, she ca... Read more
Extend Your HPI Knowledge to Assign E/M Levels Correctly
Question: One of our physician assistants believes that if she has an extended HPI, she ca... Read more
You Be the Coder:
Know How E/M Rules Differ in ED Setting
Question: Our PM specialist was called to the ED to see an established patient for an E/M ... Read more
Know How E/M Rules Differ in ED Setting
Question: Our PM specialist was called to the ED to see an established patient for an E/M ... Read more