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E/M Coding & Reimbursement Alert

Diagnosis Focus:
Walk Yourself Through Coding Spinal Stenosis
Hint: Patients may require multiple encounters before the provider pinpoints a Dx. A pati... Read more
Specialty Spotlight:
Look for These Specific Terms in Documentation to Pinpoint Urodynamics Code
Find out when you can bill a separate E/M service. A urologist may perform urodynamics t... Read more
Condition Coding:
Dive Deep Into Skull Fracture Repair Coding
Let encounter location drive E/M code choice. It's a safe bet that almost all neurosurge... Read more
Reader Questions:
Course-Correct With a Tricky Provider Conversation
Question: We have a provider in our practice that insists on adding an office/outpati... Read more
Reader Questions:
Code In-House Services Inclusively
Question: Our group practice has a radiology department that performs several ultraso... Read more
Reader Questions:
Remember New Patients are Never Incident-To
Question: A new patient came in and the nurse practitioner (NP) took the initial hist... Read more
You Be the Coder:
Do Two Feet Mean Two Problems?
Question: If a patient has a bilateral problem (for example, the patient has rheumato... Read more
Specialty Spotlight:
Get in Sync With These Major ED E/M Changes
Prepare for MDM to reign supreme. Emergency department (ED) coding will undergo some majo... Read more
Coding Update:
Understand These Long-Term Drug Therapy Code Adjustments
Hint: Side effects may affect MDM leveling. With medical records constantly on the move b... Read more
Best Practices:
Keep a List of Current Payer Policies Surrounding IUD Procedures
Surprise: Some payers won't pay for removals at all. There are myriad policies surroundin... Read more
Reader Question:
Don’t Use This Modifier in This Preventive Exam Scenario
Question: Our pediatrician saw an existing 7-week-old patient for a routine checkup with i... Read more
Reader Question:
Define 'Postconcussional' Syndrome
Question: Notes indicate that the provider performed a level-three office evaluation ... Read more
Reader Question:
Append These Modifiers for Bone Cyst Evaluation
Question: A new patient reports to the orthopedist complaining of left shoulder pain.... Read more
You Be the Coder:
Consider This Lumbar Injection Encounter
Question: Encounter notes indicate that after an office evaluation and management (E/M) se... Read more
Coding Updates:
Find Out Which 2023 Code Changes Affect Office/ Outpatient Consultations
Don't miss which modifier will be a key coding component. Spend the fall preparing for th... Read more
Best Practices:
Beware 3 Red Flags When Coding Time
Hint: Make sure hours coded match hours worked. One of the major changes in the 2021 CPT�... Read more
Specialty Spotlight:
Here’s How to Navigate Antepartum Visits Outside of Global Maternity Code
Hint: Get ready to tally. Counting is key. If your ob-gyn provides antepartum care but ... Read more
Reader Questions:
Refresh Your Understanding of PCM Services
Question: Who can provide principal care management (PCM) services, and what activiti... Read more
Reader Questions:
Understand ‘QHP’ Acronym to Code These Encounters
Question: Should I be reporting all services performed by a nurse, including those p... Read more
Reader Questions:
Consider Vaping a Form of Smoking When Coding Cessation Counseling
Question: During a follow-up E/M visit for a 19-year-old patient's chronic asthma, th... Read more
You Be the Coder:
Challenge Your Understanding of Concussion Encounters
Question: Encounter notes indicate that the provider performed an office E/M service ... Read more
2023 Updates:
Watch for Major Revisions in Hospital Coding
Say goodbye to per-day observation codes. 2023 is just around the corner, and so are upd... Read more
Back to Basics:
Don’t Rely on a New Condition for an Established Patient to Bill E/M
Hint: Lean heavily on ‘evaluation' for justification. Last month, we discussed exampl... Read more
Case Study:
Supercharge Your FBR Coding
Find out when making an incision makes a difference. Foreign body removals (FBRs) are a ... Read more
Reader Questions:
Don’t Count on a Referral to Determine MDM
Question: Our providers say that referrals are always considered low risk under the ... Read more
Reader Questions:
Remember Incident-To in Office Setting, per Medicare
Question: The primary care practitioner (PCP) and the nurse practitioner (NP) both sa... Read more
Reader Questions:
Understand Circumstances Where Patient May be Absent
Question: A patient's family came in, and our pediatrician spoke to them about the ch... Read more
You Be the Coder:
Don’t Get Tripped Up by MRI Order
Question: The provider performed an emergency department (ED) evaluation and manageme... Read more
Back to Basics:
Can You Distinguish a Procedure From an E/M Service?
Plus, know how to support, with documentation, appending modifier 25. Even expert coders... Read more
Billing:
Know Patient Status Before Billing Incident-To
Hint: Check with your payers before billing. If your practice provides services inciden... Read more
Specialty Spotlight:
Test Your Coding Knowledge With This Ob-Gyn Scenario
You may be able to report more than one E/M code for this pessary situation. Coding a pe... Read more
Reader Questions:
Look to Patient Insurance Status for Clue on Billing Second Visit
Question: One of our providers will decide that a patient has to have surgery, then h... Read more
Reader Questions:
Remember Counseling May Qualify as a Separate Service
Question: Can a GI specialist bill for alcohol abuse counseling and intervention in ... Read more
Reader Questions:
Understand When Rx Management Affects MDM
Question: Our pediatrician gave a patient a trial/sample medication. The doctor docum... Read more
You Be the Coder:
Figure Out Which Modifier is Best in This Arthrodesis Surgery Scenario
Question: Encounter notes indicate that the surgeon performed an office/outpatient ev... Read more
Billing:
Find Clarification on Observation Care for Shared Billing
Hint: Remember that documentation establishes the patient's medical narrative, too. The ... Read more
Clip and Save:
Know When to Apply an E/M Code to a Colonoscopy Encounter
Either time or medical decision making may be used if visit counts as an E/M service. So... Read more
Coding Practice:
Make an Impact When Coding Constipation
Prioritize capturing the nuances of this common condition. Constipation is a common conce... Read more
Reader Questions:
Don’t Think of CPAPs as Diagnostic
Question: A patient with sleep apnea was fitted for a continuous positive airway pres... Read more
Reader Questions:
Look to Documentation First to See if Anesthesiologist Visits Qualify for E/M Service
Question: The physician inserted a lumbar drain and wants to leave it in place for se... Read more
Reader Questions:
Include Education in E/M Selection for This Encounter
Question: Could you explain autogenic drainage? I believe it is a method for improvin... Read more
You Be the Coder:
Look to Patient Status for Appropriate E/M Code
Question: Encounter notes indicate that the provider performed an office evaluation ... Read more
Skill Builder:
Find Answers to Burning Questions About MDM
Hint: Factor undiagnosed conditions at date of service into MDM calculations. Medical dec... Read more
Emergency Medicine:
Use These 5 Benchmarking Tips to See How Your Team Compares
Where do your emergency physicians stand when it comes to national trends? One importan... Read more
Inpatient Coding:
Try Time Travel for Some Inpatient Coding Situations
Don't forget to use the right modifier where appropriate. Knowing how to report inpatien... Read more
Reader Questions:
Determine Reason for Visit When Deciding if E/M Code is Appropriate
Question: Our office manager wants to charge for an office/outpatient evaluation and... Read more
Reader Questions:
Rely on ‘New Patient’ When Choosing E/M Service Code
Question: During a level 3 office evaluation and management (E/M) service for a new patien... Read more
Reader Questions:
Stick to Documentation When Reporting Encounters Related to COVID-19
Question: Our emergency department (ED) sees a lot of patients with multiple comorbid... Read more
You Be the Coder:
Don’t Use Modifier 25 With Minor Global Period
Question: Encounter notes indicate that the provider performed osteotomies on the dis... Read more
Modifiers:
Use Modifiers Wisely to Demonstrate Separate and Distinct Services
Hint: You can't use modifier 59 on an E/M service code. If your clinician performs multip... Read more
Back to Basics:
Clear the Confusion Surrounding 99211
You cannot provide incident-to services to a new patient. Although the major changes surr... Read more
Clip and Save:
Use This Memory Trick to Ace Hospital Claims
You don't need to build a ‘palace' in your mind, just remember this acronym. There are ... Read more
Reader Questions:
Develop Splinter Removal Coding
Question: A patient came to the emergency department (ED) after she got a splinter i... Read more
Reader Questions:
Look to Context of Conditions to Choose MDM Level
Question: A patient had labs drawn and came back in to review the results. Upon revi... Read more
Reader Questions:
Remember MACs, Individual Payers Are Resources for Information
Question: For a postoperative, related evaluation and management (E/M) visit within t... Read more
You Be the Coder:
Remember Time or MDM When Selecting E/M Code Choice
Question: Encounter notes indicate that the provider performed an office evaluation a... Read more
Billing:
Unlock Your Understanding of PCM
Stay on top of current CPT® guidelines to know which services you can report along with ... Read more
Knowledge Check:
Evaluate Your Preventive Care Coding Knowledge
Hint: POS may not affect ‘new' patient status. Compare your knowledge of preventive med... Read more
Hospital Care:
Dive Deep Into CPT® Manual to Code Hospital Care
Remember that inpatient stays longer than one day may require different codes. If your pr... Read more
Knowledge Check Answers:
Understand Preventive Care Coding
See how your answers compare to the experts'. Scenario 1 Answer: For the preventive exam... Read more
Reader Questions:
Severity of a Condition Does Not Automatically Justify Higher Level E/M
Question: A patient returned for a six-month follow-up after undergoing a punch biops... Read more
Reader Questions:
Try Your Knowledge Counting These HPI Elements
Question: I have a question about history of present illness (HPI) and how it relates... Read more
Reader Questions:
Pay Attention to the Global Package for Surgery-Related Appointments
Question: One of our providers will decide that a patient has to have surgery, then h... Read more
You Be the Coder:
Focus on Fracture Presentation to Unlock Coding Pathway
Question: Notes indicate that the ED physician performed a level 5 evaluation and man... Read more
Prolonged Services:
Don’t Forget to Document These Crucial Non-Face-to-Face Components of Care
Know the do's and don'ts of capturing payment for the work beyond patient encounters. Pro... Read more
Specialty Spotlight:
Check for Anesthesia Before Using This Otolaryngology Code
Hint: Use of anesthesia in an exam may be considered atypical. Some otolaryngologic encou... Read more
Case Study:
Try Your Hand Coding This Common Podiatry Scenario
Consider patient status to choose accurate E/M service code. If you work with a podiatris... Read more
Reader Questions:
Remember An Appeal is a Tool You May Sometimes Need to Use
Question: I have a maternal fetal medicine (MFM) doctor who does an inpatient evaluat... Read more
Reader Questions:
Evaluate Two Options in This Sibling Patient Scenario
Question: A parent brought in their two children for follow-up visits of their chroni... Read more
Reader Questions:
Don’t Get Confused by the Similarities in These After-Hours Codes
Question: When it comes to billing after-hours or evening codes, is it true that ther... Read more
You Be the Coder:
Determine Coding for This Carpal Tunnel Encounter
Question: Notes indicate that the provider performed an office evaluation and managem... Read more
News You Can Use:
Dig Deep in the 2022 MPFS Final Rule Mixed Bag
Find out when Medicare won't pay teaching physicians for shared services. Teaching physici... Read more
Modifiers:
Rely on Global Periods to Help Choose Appropriate Modifier
Hint: Modifier 24 is defined by the post-op period. You know the definition for modifie... Read more
Back to Basics:
Find Answers to These 3 ROS Level Questions
Does documentation show one body system or two? The difference may cost $50. Knowing how ... Read more
Reader Questions:
Answer Sticky Established Patient Question Via Taxonomy Code
Question: If a patient sees one surgeon in our practice, then one year later sees a differ... Read more
Reader Questions:
Follow These Guidelines on Face-to-Face Encounters on Discharge Day
Question: I read that when reporting discharge day management service, we must provide and... Read more
Reader Questions:
Rely on Documentation to Prove Management of Chronic Condition
Question: If a patient has only one chronic problem that is not worsening but is not respo... Read more
Reader Questions:
Focus on Intended Procedure Rather Than Payer for Cancellation
Question: I have a cosmetic case that canceled after the pre-op exam but before induction... Read more
You Be the Coder:
Select E/M Level Code, Go All-Out on Diagnosis
Question: Notes indicate the provider performed a level-four office evaluation and managem... Read more
Specialty Spotlight:
Nail Down Ob-Gyn Preventive Medicine Coding
Hint: Note which materials the physician referenced if choosing a face-to-face counseling... Read more
Inpatient Coding:
Tackle Observation Coding With This Expertise
“Observation” sounds low-key, but coding the service can be complicated. Clarify yo... Read more
Knowledge Check:
Dial in Your Emergency Department Coding With These Scenarios
Hint: Distinguish between tests ordered and tests performed. Coding emergency departmen... Read more
Reader Questions:
Focus on ‘New’ or ‘Established’ to Unlock E/M Code for CT
Question: Notes indicate the provider performed an office evaluation and management (E/M) ... Read more
Reader Questions:
Know What Updates Mean for Modifier 25 Usage
Question: Have the modifier 25 rules changed now that the E/M guidelines are different? My... Read more
Reader Questions:
Code a Clavicle Fracture Fix Encounter Like This
Question: Encounter notes indicate that after a level-four office-evaluation and manageme... Read more
You Be the Coder:
Count Time in this Ortho E/M Encounter
Question: How should I code this follow-up visit? A patient returned to our pediatrician a... Read more
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