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E/M Coding & Reimbursement Alert

Code Updates:
Prepare Now for 2024
Know which new and established outpatient codes descriptors are changing. The CPT® 2024 ... Read more
Guidelines:
Remember These Three Things When Billing Medicare
Finally get clarification on Medicare's rules for E/M service encounters. On Aug. 29, 20... Read more
Specialty Spotlight:
Rely on These Tips When Coding Tilt Table Tests
Be careful when reporting E/M service. Cardiologists and other clinicians may see patien... Read more
Reader Question:
Go Canny When Reporting Spinal Manipulation
Question: After a level-four office evaluation and management (E/M) service for an e... Read more
Reader Question:
Assign Codes — and Responsibility for Code Choices
Question: Who is responsible for the final diagnosis used for an office/ outpatient e... Read more
Reader Question:
See Red Flags on This Patient Visit Proposition
Question: I have a provider who would like to see new patients over the course of thr... Read more
You Be the Coder:
Code This ED Earache Encounter
Question: Encounter notes indicate that during a level-three emergency department (ED... Read more
Back to Basics:
Nail Down the Rules for New Vs. Established Patients
Find out what to do if a patient follows a provider. Figuring out whether a patient is ne... Read more
Procedure Perfection:
Look to E/M First for Spinal Tap Encounters
Check whether the decision to move forward with a spinal tap occurred during an E/M servic... Read more
E/M Levels:
Get Expert Insight on the MDM Table
Hint: An ‘acute' condition may not be ‘new.' A lot of folks who are in the business ... Read more
You Be The Coder:
Rely on Documentation for Test Review
Question: Our surgeon has performed an esophageal ablation of polyps for a patient in... Read more
Reader Question:
Explore Circumstances for X{EPSU} Usage
Question: Can you explain when I should and shouldn't use the X{EPSU} modifiers? Min... Read more
Reader Question:
Specialties Matter When Categorizing Patient Visits
Question: If a patient sees one ophthalmologist in our group practice, then one year ... Read more
Reader Question:
Depend on Documentation to Establish Risk
Question: Do inherent risks, such as perforation, make all surgeries “high risk” ... Read more
Diagnosis Deep Dive:
Confidently Code a Stroke From Encounter Through Dx
Also, remember to choose the correct ICD-10-CM code for each patient. There are many opti... Read more
ED Encounters:
Beware Miscoding Complexity in the ED
Hint: Don't lean on H&P documentation for leveling. Patients that report to the emer... Read more
Specialty Spotlight:
Find Out How to Code This Common Ob-Gyn Procedure
Remember: Don't forget to consult CPT® guidelines. A patient returning for a repeat pap... Read more
Reader Questions:
Remember ‘7’ for Cumulative Service Time
Question: When our providers perform online digital E/M services (99421-99423) servi... Read more
Reader Questions:
Document Minutes Across Days
Question: Our surgeon provides some presurgical consultations digitally sometimes and... Read more
Reader Questions:
Put Postpartum Care on a Timeline
Question: I have a patient who didn't deliver with us and came back for postpartum (... Read more
You Be the Coder:
Use the Right Modifier in a Laceration Situation
Question: A patient reports to the emergency department (ED) with three lacerations o... Read more
Medicare Physician Fee Schedule:
Get the Scoop on Proposed E/M Add-On Code for CY 2024
Hint: Some providers could get a Medicare pay boost. Due to a separate add-on code for ou... Read more
Billing:
Delve Into Incident-To
Find out whether supervising physicians need to be in the same room. Utilizing incident... Read more
Specialty Spotlight:
Rely on E/M Reporting for Nosebleed Encounter
Use these 4 questions to focus your coding options. Correctly coding nosebleed treatment... Read more
Reader Questions:
Are Pre-Op Services Part of Anesthesia Care?
Question: Are there any guidelines as to when an anesthesiologist can bill separately... Read more
Reader Questions:
Know When an E/M Code Is Unnecessary
Question: When a patient undergoes intradermal dilutional testing, should we report 9... Read more
Reader Questions:
Explore Carpal Tunnel Coding from Beginning to End
Question: After a level-three evaluation and management (E/M) service for an establis... Read more
You Be the Coder:
Check Your Knowledge of NCCI Bundling
Question: Can we submit 99213 for an office visit and 92065 for vision training on th... Read more
Case Study:
Can You Navigate Coding a Celiac Dx?
Find out whether a diagnosis encounter levels best with MDM or time. Coders navigate comp... Read more
Knowledge Check:
Test Your Modifier Know-How
Find out how much you remember about modifier definitions. There are many situations in w... Read more
Documentation:
Anticipate and Eliminate Denials With This Crucial Tool
Avoid claims headaches with top-notch documentation. If you're experiencing a lot of cl... Read more
Modifiers:
Remember: Modifiers Affect Codes’ Intentions
Hint: You may want to use 76 and 77 to show repeat procedures. If you've answered the q... Read more
You Be the Coder:
Don’t Get Distracted by the Wound
Question: Our provider saw a 7-year-old who cut their left foot on a broken wood shard whi... Read more
Reader Questions:
Lean on Documentation for MWV and Separate E/M
Question: If a patient presents for a Medicare Wellness Visit (MWV) and the provider notic... Read more
Reader Questions:
Consider Vaping Synonymous with Smoking for Cessation Counsel
Question: During a follow-up evaluation and management (E/M) visit for chronic sinusitis a... Read more
Reader Questions:
Count Time Beyond Encounter for E/M
Question: One of our providers wants to bill an evaluation and management (E/M) visit usin... Read more
News You Can Use:
Heed Cigna’s Proposed Change to Forestall Denials
Beware: The claims submission process may become more restrictive. Commercial carrier Cig... Read more
Don’t Fall Prey to Common Modifier 25 Mistakes
Getting paid for modifier 25 claims has often been tricky. Check out these pointers on ea... Read more
Technology:
Delve Into Digital Health Tool Reporting
Hint: Payer policies may differ. Digital health tools are probably here to stay, and code... Read more
Specialty Spotlight:
Figure Out Whether an Encounter Involves Critical Care
Hint: Intubation isn't bundled into 99291 and +99292. When patients report to the emergen... Read more
Reader Questions:
Brush Up on Uncertain Diagnosis Rules
Question: Does an undiagnosed new problem with uncertain diagnosis automatically tra... Read more
Reader Questions:
Follow These Steps for Tick Removal
Question: A 10-year-old patient reports to the emergency department (ED) complaining ... Read more
Reader Questions:
Define Cumulative Service Time
Question: When our providers perform online digital E/M services (99421-99423) servic... Read more
You Be the Coder:
Report This Headache Case With Ease
Question: A new patient reports to the surgeon with severe headaches that have been h... Read more
Knowledge Check:
These Codes Got Heavy Use During the PHE —Now What?
Support the codes you want to use with the documentation they require. We're exploring a... Read more
Code Updates:
Check In on Inpatient/Hospital E/M Revisions
Heed experts and avoid some common mistakes. You know CPT® completely overhauled the in... Read more
Specialty Focus:
Consider E/M Facets for ED Wound Repair
Hint: Wound closure strategy matters for E/M choice. When patients present to the emergen... Read more
Reader Questions:
Recognize When ‘Reviewed’ is Tethered to an Order
Question: If the provider orders a test, does her review of that test during the fol... Read more
Reader Questions:
Beware That Decisions May Not Warrant Own Codes
Question: I billed Medicare for an EGD and a hospital inpatient visit using the 57 mo... Read more
Reader Questions:
Know Which Services Go Together
Question: The ED physician sees a patient complaining of nausea with vomiting. After... Read more
You Be the Coder:
Take Relationship Into Account in Some Coding Situations
Question: A patient came to our practice seeking a second opinion during the 90-day g... Read more
Specialty Focus:
Use This Carve Out Rule Knowledge
 Hint: A modifier can show Medicare that you know the service isn't covered. Medica... Read more
Modifiers:
Know When to Separate E/M From Surgery RVUs
Billable E/M service might be obvious, but never assume it. If an emergency department (... Read more
Diagnosis Focus:
Utilize These Tips to Navigate a Nosebleed Encounter
Sometimes, an E/M encounter may incorporate a repair. Coders need to know how to choose t... Read more
Reader Questions:
Look to Medicare for MDM Advice on Rx Management
Question: What qualifies as prescription drug management, which is a moderate-risk le... Read more
Reader Questions:
Remember This Quick Advice on Modifier 25 Usage
Question: We worry about using modifier 25 incorrectly. Can you explain key considera... Read more
Reader Questions:
Recognize When Time Need Not Be Consecutive
Question: One of our providers wants to bill an evaluation and management (E/M) visit... Read more
You Be the Coder:
Beware Reporting Screening Dx Code During E/M Encounter
Question: It looks like my providers recently started selecting their own ICD-10-CM c... Read more
Diagnosis Focus:
Note the Use of Thompson Test Amidst ED E/M
Tip: Ensure documentation explains X-Ray, MRI usage. A patient who ruptures their Achille... Read more
News You Can Use:
Understand How MPFS Clarifies E/M Code Billing
Report 99291 with critical illness or injury. The most recent Medicare Physician Fee Sche... Read more
Specialty Spotlight:
Highlight These Otolaryngology-Specific Tips for MDM
Hint: Sometimes you shouldn't count data. Having sufficient know-how on coding evaluation... Read more
Reader Questions:
See When Higher Code Level May Prevail
Question: Encounter notes indicate that on Feb. 2, 2023, the provider performed init... Read more
Reader Questions:
Consider MDM for Tests Not Performed
Question: Suppose a physician orders a diagnostic test, such as an electrocardiogram ... Read more
Reader Questions:
Prepare for End of PHE
Question: What can our practice do to prepare for the public health emergency (PHE) ... Read more
You Be the Coder:
Define ‘Stable’ For Accurate MDM
Question: We have a patient with one chronic problem. It is not worsening, but it is ... Read more
Procedure Deep Dive:
Strengthen Your Tendon Repair and Tenolysis Coding Skills
Strengthen Your Tendon Repair and Tenolysis Coding Skills These surgeries are usually pre... Read more
Specialty Spotlight:
Follow These Three Tips for Coding Vent Management
Learn the rules for vent management and E/M coding. There are several common coding mista... Read more
Documentation:
Bolster Patient Records With Accurate Documentation
Hint: Medical record notes should include both reason for encounter and plan of care. Co... Read more
Reader Questions:
Don’t Rely on Single Code for Nurse-Led Encounters
Question: Should I be reporting all services performed by a nurse, including those provide... Read more
Reader Questions:
Educate Providers to Avoid Overcoding
Question: We have a provider in our practice who insists on adding an office/outpatient ev... Read more
Reader Questions:
Don’t Double Dip on E/M Time Count
Question: Now that we can code many E/M services based on time, and we can use more than f... Read more
You Be the Coder:
Consider Use of Consult Code Carefully
Question: A 53-year-old new patient with type 1 diabetes presented to the clinic with a ch... Read more
Specialty Focus:
Rely On These 3 Tips for These Podiatry Realities
Remember: Medicare reimburses for some routine foot care services. What may be routine f... Read more
Coding Updates:
Beware These Inpatient Evaluation Red Flags
Take a deep breath after experiencing those myriad January updates. Coders who encounter... Read more
ED Coding:
Find Answers to Two ED Conundrums
Don't hesitate to give the physician credit for medical decision making. Emergency Depart... Read more
Reader Questions:
Look for ‘Postoperative Period’ as a Key Phrase
Question: A patient returns to our office for debridement two weeks after undergoing ... Read more
Reader Questions:
Make Sure the Documentation Tells the Story
Question: Encounter notes indicate that the provider performed an office evaluation a... Read more
Reader Questions:
Tune in On Patient Status for Code Reporting
Question: During an office evaluation and management (E/M) service for an established... Read more
You Be the Coder:
You May Not need a Dx to Get Paid
Question: A parent brings their infant to see the pediatrician, saying the baby had b... Read more
News You Can Use:
Check-In on This Prolonged Services Update
Look for descriptor changes that are a bit fiddly. Make sure you stay abreast of the chan... Read more
Clip & Save:
Save This Prolonged E/M Services Code Cheat Sheet
Use this chart to avoid confusion over code choice for your Medicare and private payer pat... Read more
Diagnosis Focus:
Know Which Presurgical Services Accompany a TKR
Hint: The decision for a TKR may formulate over several visits. If a provider decides tha... Read more
Procedure Deep Dive:
Use These Tips for Calculating MDM for Tetanus Shots
Don't forget to look out for side effects. How a tetanus shot fits into the Table of Ris... Read more
Reader Question:
Rely on Knowledge of This Technicality for New Versus Established Patient
Question: Our clinic had a patient come in for a wellness visit. They had only been t... Read more
Reader Question:
Reach for This E/M in G-tube Removal
Question: How is the removal of a patient's gastrostomy tube (G-tube) in an office se... Read more
Reader Question:
Know the Numbers for Smoking Cessation
Question: We have podiatry patients with peripheral neuropathy and are trying to implement... Read more
You Be the Coder:
Consider These Details in Asthma Encounter
Question: An established patient recently visited our pulmonology practice for a foll... Read more
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