E/M Coding & Reimbursement Alert

Documentation:
Review This Benchmarking Data, Stop Over-Reporting High-Level NP E/Ms
Avoid the auditing blues with this expert advice. The nurse practitioners (NPs) in your o... Read more
Countdown to 2021:
Will You Choose Time or MDM for Your 2021 E/Ms? Here’s How to Decide.
Making the wrong choice could cost your practice dearly. By now, it should be common kno... Read more
Guidelines:
Let This FAQ Solve All Your Inpatient Coding Conundrums
Don't forget to keep time on your side. While the 2021 changes to the office or other out... Read more
You Be the Coder:
Be Patient When Billing Inpatient Visits by Time
Question: Our gastroenterologist saw a colitis patient in the hospital and did not maintai... Read more
Reader Questions:
Beware of Assigning E/M in This New Patient Encounter
Question: Can we bill 99201-99205 for a patient who comes in to establish care with our pe... Read more
Reader Questions:
Test Your MDM Knowledge Before Calculating Level
Question: The 2021 office and outpatient E/M guidelines for medical decision making (MDM) ... Read more
Reader Questions:
Go With the Flow to Chart COVID Swab Collection
Question: If a provider has a telehealth visit with a patient, and the patient is then ins... Read more
Countdown to 2021:
Know if the New E/M Rules Will Affect Modifier 25 Use Next Year
These two cases will help keep your 2021 E/M-25 decisions straight. Much of the discussio... Read more
Documentation:
Take These Tips, Stabilize Your E/M 2021 Understanding
Make sure your documentation can handle the change. With just a few short weeks to go, yo... Read more
Documentation:
Look to Peer Audits to Improve E/M Documentation
One simple idea can produce big payoffs. The office/outpatient E/M codes may be changing ... Read more
You Be the Coder:
Can You Clear up This Consultation Conundrum?
Question: Our provider examined a patient, then provided information about that patient's ... Read more
Reader Questions:
Add This Knowledge to Your Nurse Visit Know-How
Question: An established patient with anemia visited our office to receive a vitamin B-12 ... Read more
Reader Questions:
Understand Split/Shared to Receive Full Reimbursement
Question: Can qualified advanced practice providers (APPs) “split” a service with a ph... Read more
Reader Questions:
Report E/M in This Tongue Packing Encounter
Question: Our practice saw a patient who had bitten her tongue and lip following a dental ... Read more
News You Can Use:
Evaluate CMS’ Proposed PFS, Manage Your 2021 E/M Expectations
E/M fees could go up or down, while prolonged services coding could get sticky. You proba... Read more
CPT® 2021 Revisions:
Get Ready for These 2021 CPT® E/M Revisions
If you think many of these changes look familiar, you're right! While the E/M section of ... Read more
Countdown to 2021:
Learn How to Speak the Language of the 2021 MDM Changes
Hear what the experts are saying about how revised MDM verbiage will affect documentation.... Read more
You Be the Coder:
Don’t Be Out to Lunch Coding This Incident-To Scenario
Question: We reported 99211 for a nurse visit with a Medicare patient when the provider wa... Read more
Reader Question:
Mend Your Understanding of This Facture Care Scenario
Question: Can we report an E/M code for comfort care if we confirm that fracture care was ... Read more
Reader Question:
Get Critical With This Threshold Guideline
Question: Which code should we report if the physician sees a critically ill patient for l... Read more
Reader Question:
Can You Report E/M With Cauterization Services?
Question: Is it possible to bill a separate evaluation and management (E/M) service for a ... Read more
Countdown to 2021:
Read This Refresher to Fast-Track Your 2021 MDM Implementation
Don't panic. Time is still on your side to master the big E/M coding change. If you haven... Read more
Telehealth:
Pay Attention to These Details, Prepare for Post-COVID Audits
Check for time, audio/video documentation to keep telehealth claims clean. From a medica... Read more
Compliance:
Want to Get More Specific With Your Telehealth Documentation? Here’s How.
Hint: Don't let the time tick away. In the previous article, we discussed some of the g... Read more
You Be the Coder:
Establish the Real Status of These New Patients
Question: We are aware of the new patient rules for E/M visits, but this situation is a ne... Read more
Reader Questions:
Evaluate This Question, Manage Your Answer for 2021 E/M Services
Question: Is it true that E/M coding for office and outpatient visits will be based on med... Read more
Reader Questions:
Modify Your Answer to This Preventive Bundling Question
Question: The patient underwent 99395 25, 81000, 58301-59, 99406 on the same day. How shou... Read more
Reader Questions:
Pay Attention to This Follow-Up Medication Encounter
Question: What codes should we use for attention deficit disorder (ADD)/attention-deficit ... Read more
Reader Questions:
Combine These E/M Encounters at Your Peril
Question: One of my physicians would like to see new patients over the course of three sep... Read more
Documentation:
Take These 3 Tips, Get Your E/M Coding Back on Track
Templates, guidelines, and remote monitoring top E/M challenges say experts. No matter wh... Read more
Countdown to 2021:
Code This Case Study, Keep Next Year's Office and Outpatient E/Ms On the Level
Read on and see what could happen to your bottom line in 2021. If you've been wondering h... Read more
Guidelines:
Calculate Components for Correct Consultation Coding
Remember — there's always 2 sides to the 99446-99449 story. You might not get to code i... Read more
You Be the Coder:
Know How to Avoid This Incident-to Error
Question: We reported 99211 for a nurse visit with a Medicare patient when the provider wa... Read more
Reader Questions:
Expand This Documentation of Family History
Question: Our provider documented “No sick contacts.” Would this be enough to fulfill ... Read more
Reader Questions:
End This EOL Modifier Mistake
Question: Our provider recently counseled an established patient on end-of-life (EOL) dire... Read more
Specialty Spotlight:
Make a Pain-Free Transition to 2021 Time Guidelines
Here's how things will change for pain management coders. The upcoming changes to the off... Read more
Modifier Use:
Let These 7 Pointers Guide You Through the Modifier Minefield
Part B reps clear up modifier 24, 25 confusion. Knowing when to apply modifiers to E/M se... Read more
Testing:
Code Cognitive Assessments Correctly With this Expert Advice
Understand all the strings attached to 99483. There are so many rules surrounding 99483 (... Read more
Reader Questions:
Will History, Exam Stay or Go in 2021? The Answer May Surprise You.
Question: Since history and exam will no longer be key components for determining the... Read more
Reader Questions:
Visit This Code for Sunday After-Hours Telemedicine E/Ms
Question: We normally have office hours on a Sunday and bill 99051 for those services... Read more
Reader Questions:
Know This New Practice, New Patient Rule
Question: When a physician joins a new practice and sees patients from the former pra... Read more
Reader Questions:
Reporting 99211 for BP Checks? Not So Fast.
Question: Doctor orders blood pressure (BP) check at our nurse's station. The diagnos... Read more
You Be the Coder:
Can You Resolve This IUD Removal/Insertion and E/M Scenario?
Question: My ob-gyn either inserts or removes an IUD at the same time as an E/M or pr... Read more
Countdown to 2021:
Take a Closer Look at the 2021 Changes to Outpatient E/M Times
Total times, prolonged services get major overhaul. In the April issue of E/M Coding Ale... Read more
Specialty Spotlight:
Understand These Criteria for Correct Peds Critical Care Coding
Beware of bundling difference between the two, experts say. Because “critical care is ... Read more
Care Management:
Take Care to Cultivate CCM in Your Practice
Here's how to create and maintain a program for chronically ill patients. A chronic car... Read more
You Be the Coder:
Look at These Rules for Accurate Observation Care Reporting
Question: Which code set should we use when the gastroenterologist admits a patient to obs... Read more
Reader Question:
Modify This E/M, Aspiration Encounter
Question: An established patient reports with right knee and thigh pain. During an E/M ser... Read more
Reader Question:
Examine Your Documentation for Telehealth Visits
Question: Due to the COVID-19 pandemic, our providers are performing mostly telehealt... Read more
News You Can Use:
Confused by the Current COVID-19 Telehealth Waivers? Here's What You Need to Know
CMS' Interim Rule changes guidelines, adds to code list. On March 31, 2020, the Cente... Read more
Guidelines:
Understand Telehealth by Studying These 3 Scenarios
Make modifier mistakes a thing of the past. Virtual check-ins. POS modifiers. There's a... Read more
CPT® Updates:
Pay Attention to These Corrections, Update Your E/M Understanding
Know what the AMA revised in its latest errata list. With everything going on at the mo... Read more
You Be the Coder:
Know What Is, Is Not Included In This Preventive Care Encounter
Question: A 50-year-old new male patient with a strong family history of cancer reported t... Read more
Reader Question:
Be Critical of These Codes in CCU Situations
Question: When our provider rounds on a patient in the critical care unit (CCU), can we us... Read more
Reader Question:
Take Time To Add These Multi-Provider Minutes
Question: One of our providers spent 40 minutes treating a critically ill adult patient in... Read more
Reader Question:
Fine-Tune Your Modifier 24 Use With This Advice
Question: We just used modifier 24 for the first time and now we're worried we may have u... Read more
Countdown to 2021:
Get Your GI Practice Ready for the 2021 E/M Overhaul
Know how these 3 changes will affect you next year. Office and outpatient E/M visits are ... Read more
Specialty Spotlight:
Focus on E/M for Presurgical Fracture Care
Global period key to modifier choice. Can you code for an E/M service if your orthopedi... Read more
Documentation:
Study These 4 Suggestions, Sharpen Your E/M Savvy
Experts offer their advice for best practices. Accurate documentation produces accurate E... Read more
You Be the Coder:
Modify Your Understanding of E/M-Venipuncture Encounters
Question: Should I apply modifier 25 onto an E/M visit code (in this case, 99213) when my ... Read more
Reader Question:
Reach for E/M When Provider Removes Unimpacted Cerumen
Question: Our pediatrician removed cerumen from a patient's left and right ears. The cerum... Read more
Reader Question:
Be Critical of Using 99291 for Vent Management
Question: Our pulmonologist oversaw vent management for an inpatient last week and billed ... Read more
Reader Question:
Use This Answer to Code Split Preventive Services
Question: If a patient was seen by her Primary Care Physician for an annual checkup, ... Read more
Countdown to 2021:
Be Ready to Change Your New Patient Outpatient E/M Coding
On Jan. 1, 2021, 99201 will be no more. CPT® code 99201 (Office or other outpatient... Read more
Critical Care:
Get Critical With This 99291/+99292 FAQ
Hint: guidelines, bundling, and times key to clean critical care claims. Even if you're a... Read more
Telemedicine:
Keep Telemedicine Claims Safe From OIG's Scrutiny
Pill mills, telemedicine fraud high on Feds' watch list. With the opioid epidemic showing... Read more
Reader Question:
Take This Advice, Modify Double Dx Decisions
Question: We know that most insurers say separate diagnoses are not required to use modifi... Read more
Reader Question:
Evaluate Elements in This Subsequent Care Scenario
Question: One of our young patients was just hospitalized for acute gastroenteritis and de... Read more
Reader Question:
Report E/M in This Eyelid Encounter
Question: Our physician performed chemodenervation to treat a bilateral blepharospasm on a... Read more
Reader Question:
Observe This Answer for Accurate Admissions Account
Question: Our ob-gyn saw a patient on 2/1/20 and then admitted her on 2/2/20. What code sh... Read more
You Be the Coder:
Think Twice Before Prolonging Neonatal Intensive Care
Question: If we bill 99468 for neonatal intensive care, can we also bill a prolonged servi... Read more
Countdown to 2021:
Know What Stays, What Goes, in the 2021 E/M Shakeup
Say goodbye to 99201, hello to 99XXX. Though it didn't deliver the final word, the 2020 M... Read more
Guidelines:
Take These 4 Tips for Precision Online Digital E/M Coding
Here are all the guidelines you need to know to bill 99421-99423. The deletion of 99444 a... Read more
Specialty Spotlight:
Keep Your ED Coding on the Level With This Advice
MI, trauma cases don't always add up to 99285. When a reader recently asked us whether al... Read more
Reader Question:
Get the Timing Right Before Coding for Prolonged Service
Question: Our interventional radiologist saw a patient during an E/M service for a prolong... Read more
Reader Question:
Don't Modify This E/M Venipuncture Scenario
Question: Should I apply a modifier 25 onto an E/M visit code (992xx) when my oncologist p... Read more
Reader Question:
Look to These Guidelines to Know Your History
Question: Would you consider a physician documenting “No sick contacts” acceptabl... Read more
You Be the Coder:
Want to Bill 99241-99245 Frequently? Consult the Answer to This Question
Question: Our ophthalmologist performed an office consul­tation on a patient and his insu... Read more
Countdown to 2021:
Begin the Countdown to 2021 by Taking These 2 Steps
Now's the time to get ready for the new office/outpatient E/M coding changes. In just 12 ... Read more
Care Management:
Are You Making These 5 Big Changes to Your Care Management Coding?
Here's how TCM, CCM can boost your 2020 revenue stream. The addition of principal care ma... Read more
Specialty Spotlight:
Improve Your Ob-gyn Preventive Care Coding With These Pointers
Know the ins and outs of reporting 99401-99404. Do you know how to apply 99401-99404, the... Read more
Reader Question:
Stimulate Your Understanding of Reporting E/M With This Code
Question: The provider saw a patient for an outpatient E/M service. During the physical ex... Read more
Reader Question:
Don't Sneeze at This E/M, Allergy Testing Advice
Question: Following allergy testing, the physician meets with the patient to go over the r... Read more
Reader Question:
Add This Knowledge to Prolong Your E/M Coding
Question: What does the plus symbol in front of some E/M service codes signify? Connectic... Read more
You Be the Coder:
Take Time to Code This E/M Encounter by the Book
Question: One of our providers wants to report 99203, using time to meet the level require... Read more
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