E/M Coding & Reimbursement Alert
Specialty Spotlight:
Use These Tips to Earn Ethical Payment For Provider’s Time
Remember: Time is on your side. Parents across the country worry when their kids seem out... Read more
Use These Tips to Earn Ethical Payment For Provider’s Time
Remember: Time is on your side. Parents across the country worry when their kids seem out... Read more
Code Updates:
If 2021 Updates Were Painful, Brace for 2023
The first glimpse of updates includes changes to musculoskeletal guidelines. 2022 may b... Read more
If 2021 Updates Were Painful, Brace for 2023
The first glimpse of updates includes changes to musculoskeletal guidelines. 2022 may b... Read more
Medicare Part B:
Pinpoint New Fixes for Part B E/M Coding Mistakes
Hint: A check-box template may not be sufficient for showing medical necessity. If you ... Read more
Pinpoint New Fixes for Part B E/M Coding Mistakes
Hint: A check-box template may not be sufficient for showing medical necessity. If you ... Read more
Reader Questions:
Look to 99283 for This Shoulder Injury
Question: Encounter notes indicate that the provider performed a level three ED E/M servic... Read more
Look to 99283 for This Shoulder Injury
Question: Encounter notes indicate that the provider performed a level three ED E/M servic... Read more
Reader Questions:
Note Multiple Differentials and Rx When Calculating MDM
Question: An established patient came to our office complaining of left-sided facial pain ... Read more
Note Multiple Differentials and Rx When Calculating MDM
Question: An established patient came to our office complaining of left-sided facial pain ... Read more
Reader Questions:
Remember This Rule for ‘Established’ Patient Categorization
Question: A family practice provider in our large practice saw a patient, and the patient ... Read more
Remember This Rule for ‘Established’ Patient Categorization
Question: A family practice provider in our large practice saw a patient, and the patient ... Read more
You Be the Coder:
Don’t Upcode This Injury Follow-Up Visit
Question: How should I code this follow-up visit? A patient returned to our pediatrician a... Read more
Don’t Upcode This Injury Follow-Up Visit
Question: How should I code this follow-up visit? A patient returned to our pediatrician a... Read more
Specialty Spotlight:
For Mod 25, Remember The Phrase ‘In Addition To That of The Procedure’
Here's what your documentation needs to show. Now that coders must select encounter and m... Read more
For Mod 25, Remember The Phrase ‘In Addition To That of The Procedure’
Here's what your documentation needs to show. Now that coders must select encounter and m... Read more
Coding Quiz:
Test Your Knowledge of AI Modifier
Medicare may not pay, but look to private payers to get the money you've earned. Check ... Read more
Test Your Knowledge of AI Modifier
Medicare may not pay, but look to private payers to get the money you've earned. Check ... Read more
Code Update:
Get Specific with This 99211 Adjustment
2022 may bring a change that will finally bring it in line with other office/outpatient E... Read more
Get Specific with This 99211 Adjustment
2022 may bring a change that will finally bring it in line with other office/outpatient E... Read more
Coding Quiz Answers:
Are You an E/M Expert? Get Your Answers Here
Rely on your MAC when deciding whether to use an unlisted E/M code. Compare your choices... Read more
Are You an E/M Expert? Get Your Answers Here
Rely on your MAC when deciding whether to use an unlisted E/M code. Compare your choices... Read more
Reader Questions:
Answer These Three Questions for Modifier 24 Use
Question: What are the proper situations to use modifier 24? We are having a debate in the... Read more
Answer These Three Questions for Modifier 24 Use
Question: What are the proper situations to use modifier 24? We are having a debate in the... Read more
Reader Questions:
Use These Guidelines When Calculating Risk
Question: In the current CPT® Elements of Medical Decision Making (MDM) table, one of the... Read more
Use These Guidelines When Calculating Risk
Question: In the current CPT® Elements of Medical Decision Making (MDM) table, one of the... Read more
Reader Questions:
Who Called Whom? It Matters for These Codes
Question: To cut down on the number of patients in our office during the COVID-19 pandemic... Read more
Who Called Whom? It Matters for These Codes
Question: To cut down on the number of patients in our office during the COVID-19 pandemic... Read more
You Be the Coder:
You May Need Two Codes For This Navel Encounter
Question: An insurance company has just denied us for an umbilical granuloma, telling us t... Read more
You May Need Two Codes For This Navel Encounter
Question: An insurance company has just denied us for an umbilical granuloma, telling us t... Read more
Specialty Spotlight:
Discover How to Capture Severity in These Pediatric Pulmonology Scenarios
Hint: You may need to append a modifier. Exercise-induced bronchospasm (EB) and exercise... Read more
Discover How to Capture Severity in These Pediatric Pulmonology Scenarios
Hint: You may need to append a modifier. Exercise-induced bronchospasm (EB) and exercise... Read more
Telehealth:
Don’t Get Lax on Telehealth Rules
Remember: There are different rules for synchronous audio/visual meetings versus telephone... Read more
Don’t Get Lax on Telehealth Rules
Remember: There are different rules for synchronous audio/visual meetings versus telephone... Read more
Emergency Department:
Here’s Why You Should Disregard the 2021 E/M Updates for These ED Services
Don't bother with prolonged service coding in the ED. If your provider goes back and fort... Read more
Here’s Why You Should Disregard the 2021 E/M Updates for These ED Services
Don't bother with prolonged service coding in the ED. If your provider goes back and fort... Read more
You Be the Coder:
Triaging a Patient May Not Qualify as E/M Service
Question: We have been getting calls from patients who have tested positive for COVID-19 a... Read more
Triaging a Patient May Not Qualify as E/M Service
Question: We have been getting calls from patients who have tested positive for COVID-19 a... Read more
Reader Questions:
Follow These Dos and Don’ts of Billing 99211
Question: What are the minimum documentation requirements needed to bill 99211? What has ... Read more
Follow These Dos and Don’ts of Billing 99211
Question: What are the minimum documentation requirements needed to bill 99211? What has ... Read more
Reader Questions:
Satisfy MDM or Time Requirement for E/M Code
Question: Notes indicate that the provider performed an office evaluation and management (... Read more
Satisfy MDM or Time Requirement for E/M Code
Question: Notes indicate that the provider performed an office evaluation and management (... Read more
Reader Questions:
Don’t Use Prolonged Service for Extra E/M Time
Question: Our provider performed an office evaluation and management (E/M) service for a n... Read more
Don’t Use Prolonged Service for Extra E/M Time
Question: Our provider performed an office evaluation and management (E/M) service for a n... Read more
Prolonged Services:
Add One More Step to Your Billing Workflow to Appease CMS
Hint: You cannot add prolonged service codes to service levels calculated by medical decis... Read more
Add One More Step to Your Billing Workflow to Appease CMS
Hint: You cannot add prolonged service codes to service levels calculated by medical decis... Read more
Documentation:
Prioritize Coding These ‘Minor’ Visits to Ethically Boost Your Bottom Line
Missing a F2F component may not totally diminish an encounter. Your providers sometimes n... Read more
Prioritize Coding These ‘Minor’ Visits to Ethically Boost Your Bottom Line
Missing a F2F component may not totally diminish an encounter. Your providers sometimes n... Read more
Specialty Spotlight:
Be Precise When Coding Repeat Pap Smear Visits
Some payers care whether the retest is diagnostic. For a female patient to return to yo... Read more
Be Precise When Coding Repeat Pap Smear Visits
Some payers care whether the retest is diagnostic. For a female patient to return to yo... Read more
You Be the Coder:
Count on New Prescription to Code This Encounter
Question: An established patient comes in for a routine evaluation and management (E/M) vi... Read more
Count on New Prescription to Code This Encounter
Question: An established patient comes in for a routine evaluation and management (E/M) vi... Read more
Reader Questions:
Talking Shop May Not Pay
Question: Our ophthalmologist treated a patient with severe eye injuries due to a car acci... Read more
Talking Shop May Not Pay
Question: Our ophthalmologist treated a patient with severe eye injuries due to a car acci... Read more
Reader Questions:
Look to Criteria for Drug Therapy
Question: What qualifies as “drug therapy requiring monitoring” in the high-risk leve... Read more
Look to Criteria for Drug Therapy
Question: What qualifies as “drug therapy requiring monitoring” in the high-risk leve... Read more
Reader Questions:
Use One Bullet for Test Order and Review
Question: I am still getting used to the new rules for office/outpatient evaluation and ma... Read more
Use One Bullet for Test Order and Review
Question: I am still getting used to the new rules for office/outpatient evaluation and ma... Read more
E/M Update:
Find Out How Coders Are Faring With 2021 Updates
Don't be surprised if more updates tweak the codes just as you're getting familiar with th... Read more
Find Out How Coders Are Faring With 2021 Updates
Don't be surprised if more updates tweak the codes just as you're getting familiar with th... Read more
Specialty Spotlight:
Capitalize on These 10 Tips to Code ED Encounters at Higher Level
Hint: Look to HPI to “set tone” for visit. History is one of three components, alon... Read more
Capitalize on These 10 Tips to Code ED Encounters at Higher Level
Hint: Look to HPI to “set tone” for visit. History is one of three components, alon... Read more
Reader Questions:
Avoid This Modifier for E/M Services
Question: We reported 99212 with an injection code, and appended modifier 59 to the claim,... Read more
Avoid This Modifier for E/M Services
Question: We reported 99212 with an injection code, and appended modifier 59 to the claim,... Read more
Reader Questions:
Stay Compliant Despite This Bundling Dilemma
Question: Is there anything I can do from a coding perspective to prevent bundling denials... Read more
Stay Compliant Despite This Bundling Dilemma
Question: Is there anything I can do from a coding perspective to prevent bundling denials... Read more
Reader Questions:
Look at Black and White Results in This Clinical Urology Scenario
Question: My physician initially attempted to pass a catheter using tactile guidance but c... Read more
Look at Black and White Results in This Clinical Urology Scenario
Question: My physician initially attempted to pass a catheter using tactile guidance but c... Read more
You Be the Coder:
Try This Coding Sequence for Acid Reflux Encounter
Question: A primary care physician referred a patient with severe heartburn to one of our ... Read more
Try This Coding Sequence for Acid Reflux Encounter
Question: A primary care physician referred a patient with severe heartburn to one of our ... Read more
Guidelines:
5 Tips to Capture the Maximum Ethical Reimbursement for Inpatient Consults
Don't rely on hospital E/M codes until you confirm inpatient status. Picture this: Anoth... Read more
5 Tips to Capture the Maximum Ethical Reimbursement for Inpatient Consults
Don't rely on hospital E/M codes until you confirm inpatient status. Picture this: Anoth... Read more
Back to Basics:
Use Knowledge of Medical Necessity to Better Your Documentation
Hint: Your documentation can justify medical necessity, too. You may be familiar with the... Read more
Use Knowledge of Medical Necessity to Better Your Documentation
Hint: Your documentation can justify medical necessity, too. You may be familiar with the... Read more
Case Study:
Untangle This E/M Scenario to Choose the Best Possible Codes
Hint: Remember the anatomical modifier. As a coder, you know that E/M service codes are o... Read more
Untangle This E/M Scenario to Choose the Best Possible Codes
Hint: Remember the anatomical modifier. As a coder, you know that E/M service codes are o... Read more
You Be the Coder:
Look to This Code Range for Contraceptive Counseling
Question: If a patient comes in for family planning counseling, and our pediatrician admin... Read more
Look to This Code Range for Contraceptive Counseling
Question: If a patient comes in for family planning counseling, and our pediatrician admin... Read more
Reader Questions:
Know When Time Earns You More Money
Question: I have an operative report in front of me that is a bit confusing. Notes indicat... Read more
Know When Time Earns You More Money
Question: I have an operative report in front of me that is a bit confusing. Notes indicat... Read more
Reader Questions:
Don’t Use These MDM Tables Interchangeably
Question: Both the Elements of Medical Decision Making (MDM) table in the 2021 CPT® Manua... Read more
Don’t Use These MDM Tables Interchangeably
Question: Both the Elements of Medical Decision Making (MDM) table in the 2021 CPT® Manua... Read more
Reader Questions:
Don’t Consider a Ventilating Tube a Foreign Body
Question: Our provider removed a ventilating tube using a binocular microscope during an o... Read more
Don’t Consider a Ventilating Tube a Foreign Body
Question: Our provider removed a ventilating tube using a binocular microscope during an o... Read more
Hospital Service:
Ground Your Inpatient Hospital Coding in This Guidance
Hint: All E/M services by the same specialty/same provider should be combined during that... Read more
Ground Your Inpatient Hospital Coding in This Guidance
Hint: All E/M services by the same specialty/same provider should be combined during that... Read more
Modifiers:
Bust These 5 Myths to Ease Your Modifier 24 Challenges
Tip: Instead of relying on your clinic schedule for documentation proof, do this. Knowin... Read more
Bust These 5 Myths to Ease Your Modifier 24 Challenges
Tip: Instead of relying on your clinic schedule for documentation proof, do this. Knowin... Read more
Reader Questions:
Count Prescription Drug Management As MDM — With This Documentation
Question: Our pulmonologist advised a patient to continue taking a given medication at the... Read more
Count Prescription Drug Management As MDM — With This Documentation
Question: Our pulmonologist advised a patient to continue taking a given medication at the... Read more
Reader Questions:
Be Wary of Private Payer Interpretations for This Common Pediatric Scenario
Question: The 2021 revisions to the office/outpatient evaluation and management (E/M) code... Read more
Be Wary of Private Payer Interpretations for This Common Pediatric Scenario
Question: The 2021 revisions to the office/outpatient evaluation and management (E/M) code... Read more
Reader Questions:
Live By The Physician’s Documentation
Question: Is it against the rules to bill an E/M code instead of code 11721? Maryland Su... Read more
Live By The Physician’s Documentation
Question: Is it against the rules to bill an E/M code instead of code 11721? Maryland Su... Read more
You Be the Coder:
Know Payer Rules to Use This Additional Code for Service by Telephone
Question: Our surgeon performed an E/M service over the phone that lasted 55 minutes. Can ... Read more
Know Payer Rules to Use This Additional Code for Service by Telephone
Question: Our surgeon performed an E/M service over the phone that lasted 55 minutes. Can ... Read more
News You Can Use:
Want to Increase Your E/M Claim Accuracy? Incorporate These AMA Clarifications
Use these guideline updates to clarify your coding choices. The American Medical Associat... Read more
Want to Increase Your E/M Claim Accuracy? Incorporate These AMA Clarifications
Use these guideline updates to clarify your coding choices. The American Medical Associat... Read more
Guidelines:
Test Your 2021 E/M Coding Guideline Expertise with 3 Examples
Hint: Know the three components you need to report 99213. Now that gastroenterology code... Read more
Test Your 2021 E/M Coding Guideline Expertise with 3 Examples
Hint: Know the three components you need to report 99213. Now that gastroenterology code... Read more
Specialty Spotlight:
Get To Know These 3 Common Code Ranges for Otolaryngology
Use the hospital census status to determine coding. If you've ever struggled to disting... Read more
Get To Know These 3 Common Code Ranges for Otolaryngology
Use the hospital census status to determine coding. If you've ever struggled to disting... Read more
Reader Questions:
Follow These Bullet Rules
Question: For medical decision making (MDM) coding, should you count the order and review ... Read more
Follow These Bullet Rules
Question: For medical decision making (MDM) coding, should you count the order and review ... Read more
Reader Questions:
Don’t Be Hemmed in By This Suture Situation
Question: Our pediatric practice is a part of a health system run by a local hospital. One... Read more
Don’t Be Hemmed in By This Suture Situation
Question: Our pediatric practice is a part of a health system run by a local hospital. One... Read more
Reader Questions:
Look to Admitting Physician to Use This Code
Question: When should I use 99221-99223 or 99234-99236 for inpatient care? Michigan Subs... Read more
Look to Admitting Physician to Use This Code
Question: When should I use 99221-99223 or 99234-99236 for inpatient care? Michigan Subs... Read more
You Be the Coder:
Look to Critical Care Code in This Vent Situation
Question: Our pulmonologist performed vent management on a critically ill patient. We repo... Read more
Look to Critical Care Code in This Vent Situation
Question: Our pulmonologist performed vent management on a critically ill patient. We repo... Read more
Specialty Spotlight:
Refresh Your Urgent Care E/M Understanding
Here's how UCC coding has, and has not, changed in 2021. If you're familiar with emergen... Read more
Refresh Your Urgent Care E/M Understanding
Here's how UCC coding has, and has not, changed in 2021. If you're familiar with emergen... Read more
Care Management:
Take Care to Know These CCM Changes
2021 CPT® revisions lighten the CCM coding burden. In E/M Coding Alert volume 8 issue ... Read more
Take Care to Know These CCM Changes
2021 CPT® revisions lighten the CCM coding burden. In E/M Coding Alert volume 8 issue ... Read more
Prolonged Services:
Use This Guide to Reduce Prolonged Services Agony
Learn the difference between +99417 and G2212. If you thought getting reimbursed for prol... Read more
Use This Guide to Reduce Prolonged Services Agony
Learn the difference between +99417 and G2212. If you thought getting reimbursed for prol... Read more
Reader Questions:
Look to Global for Modifier Success
Question: Notes indicate that after a level-four outpatient E/M service for an established... Read more
Look to Global for Modifier Success
Question: Notes indicate that after a level-four outpatient E/M service for an established... Read more
Reader Questions:
Report This Second E/M at Your Peril
Question: Our provider saw a patient who was experiencing shoulder pain. The provider deci... Read more
Report This Second E/M at Your Peril
Question: Our provider saw a patient who was experiencing shoulder pain. The provider deci... Read more
Reader Questions:
Add These Inpatient Codes to Your COVID Telehealth List
Question: Can we report inpatient telehealth E/M services to Medicare? This has happened i... Read more
Add These Inpatient Codes to Your COVID Telehealth List
Question: Can we report inpatient telehealth E/M services to Medicare? This has happened i... Read more
You Be the Coder:
Be Critical of Using This Code in Psychiatric Encounters
Question: Can we report critical care for a patient with suicidal ideation? Our coders hav... Read more
Be Critical of Using This Code in Psychiatric Encounters
Question: Can we report critical care for a patient with suicidal ideation? Our coders hav... Read more
Specialty Spotlight:
Know How to Code Minor Procedures with E/Ms Now the Rules Have Changed
Hint: Modifier 25 still applies. Knowing when, or even if, you can code an office/outpati... Read more
Know How to Code Minor Procedures with E/Ms Now the Rules Have Changed
Hint: Modifier 25 still applies. Knowing when, or even if, you can code an office/outpati... Read more
Modifiers:
Answer These 3 Questions for Modifier 24 Success
2021 office/outpatient E/M changes won't affect its use, experts say. Knowing how to use ... Read more
Answer These 3 Questions for Modifier 24 Success
2021 office/outpatient E/M changes won't affect its use, experts say. Knowing how to use ... Read more
Telehealth:
Learn These Facts, Clear up Telehealth Confusion
Part B MAC reps set the record straight. With all the changes to telehealth brought abou... Read more
Learn These Facts, Clear up Telehealth Confusion
Part B MAC reps set the record straight. With all the changes to telehealth brought abou... Read more
Reader Questions:
Take This Advice for Coding Same Day Telehealth, Chemo Services
Question: Our providers are now doing telehealth visits, and the patient is also seen for ... Read more
Take This Advice for Coding Same Day Telehealth, Chemo Services
Question: Our providers are now doing telehealth visits, and the patient is also seen for ... Read more
Reader Questions:
Depend on the Answer to This Independent Historian Question
Question: Our urgent care center saw an infant for an upper respiratory infection. Under t... Read more
Depend on the Answer to This Independent Historian Question
Question: Our urgent care center saw an infant for an upper respiratory infection. Under t... Read more
You Be the Coder:
Count Tests This Way for Correct MDM Calculations
Question: In the article “Sharpen Your MDM Knowledge With This Quiz,” published in E/M... Read more
Count Tests This Way for Correct MDM Calculations
Question: In the article “Sharpen Your MDM Knowledge With This Quiz,” published in E/M... Read more
Preventive Medicine:
Prevent Documentation Problems With These 99381-99396 Recommendations
Code descriptors only tell part of the story. You know that preventive medicine E/M servi... Read more
Prevent Documentation Problems With These 99381-99396 Recommendations
Code descriptors only tell part of the story. You know that preventive medicine E/M servi... Read more
Specialty Spotlight:
Get to the Heart of the E/M Transition
Here's how the new office/outpatient guidelines will affect cardiology. At the moment, yo... Read more
Get to the Heart of the E/M Transition
Here's how the new office/outpatient guidelines will affect cardiology. At the moment, yo... Read more
Telehealth:
PREP Yourself for These Updated COVID Telehealth Rules
Heed this expert advice to stay safe and compliant. If you feel like you can't keep up wi... Read more
PREP Yourself for These Updated COVID Telehealth Rules
Heed this expert advice to stay safe and compliant. If you feel like you can't keep up wi... Read more
Reader Questions:
Test Your Knowledge of MDM Data Guidelines
Question: If a provider is billing based on medical decision making (MDM), not on time, ca... Read more
Test Your Knowledge of MDM Data Guidelines
Question: If a provider is billing based on medical decision making (MDM), not on time, ca... Read more
Reader Questions:
Modify Your AWV Understanding in This Encounter
Question: Do I need to use a modifier when billing 87491 with an annual wellness visit? M... Read more
Modify Your AWV Understanding in This Encounter
Question: Do I need to use a modifier when billing 87491 with an annual wellness visit? M... Read more
Reader Questions:
Don’t Look to Bundle These E/Ms Together
Question: Our new office manager is facing some confusion about what codes we would report... Read more
Don’t Look to Bundle These E/Ms Together
Question: Our new office manager is facing some confusion about what codes we would report... Read more
You Be the Coder:
Keep Your Eyes on the Calendar, Code This Encounter Correctly
Question: An established patient reports to the provider for an office E/M service. The pr... Read more
Keep Your Eyes on the Calendar, Code This Encounter Correctly
Question: An established patient reports to the provider for an office E/M service. The pr... Read more
News You Can Use:
Get Your First Look at the New Medicare Prolonged/ Complex Service Codes
Learn the pros and cons of G2211 and G2212. Thanks to the Centers for Medicare & Medi... Read more
Get Your First Look at the New Medicare Prolonged/ Complex Service Codes
Learn the pros and cons of G2211 and G2212. Thanks to the Centers for Medicare & Medi... Read more
Coding Quiz:
Sharpen Your MDM Knowledge With This Quiz
Find out if your 2021 office/outpatient E/M savvy is up to speed. If you're still a littl... Read more
Sharpen Your MDM Knowledge With This Quiz
Find out if your 2021 office/outpatient E/M savvy is up to speed. If you're still a littl... Read more
Specialty Spotlight:
Know When, When Not, to Code Pap Services With Physicals
Medicare says yes; CPT® not so much. When your female patients report for their yearly p... Read more
Know When, When Not, to Code Pap Services With Physicals
Medicare says yes; CPT® not so much. When your female patients report for their yearly p... Read more
Coding Quiz Answers:
Check Your Answers to Our MDM Coding Quiz
Time to find out how well you're dealing with the 2021 office/outpatient E/M changes. Onc... Read more
Check Your Answers to Our MDM Coding Quiz
Time to find out how well you're dealing with the 2021 office/outpatient E/M changes. Onc... Read more
Reader Questions:
Take This Counsel, Know if You Can Bill for COVID Advice
Question: Our practice is counseling a lot of Medicare beneficiaries about the importance ... Read more
Take This Counsel, Know if You Can Bill for COVID Advice
Question: Our practice is counseling a lot of Medicare beneficiaries about the importance ... Read more
Reader Questions:
Consult Guidelines Before Billing These Codes
Question: Our physician offered consultation services to a patient who was in treatment wi... Read more
Consult Guidelines Before Billing These Codes
Question: Our physician offered consultation services to a patient who was in treatment wi... Read more
Reader Questions:
Use Dx to Separate Well Check from E/M
Question: A mother brings her daughter in for her four-year-old follow up after chemothera... Read more
Use Dx to Separate Well Check from E/M
Question: A mother brings her daughter in for her four-year-old follow up after chemothera... Read more
You Be the Coder:
Looking for an Admit Code? Think Again
Question: Our provider often does rounds at the hospital and the other day, he admitted a ... Read more
Looking for an Admit Code? Think Again
Question: Our provider often does rounds at the hospital and the other day, he admitted a ... Read more