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E/M Coding Alert

Correct Coding Initiative:
Update Your Coding with 3 Sets of CCI 20.3 E/M Edits
Take advantage of the bundles with a ‘1’ modifier indicator and get paid for... Read more
Key Elements:
Avoid 5 Common E/M Errors With These Expert Tips, Part 2
Find out why under-coding is just as bad as over-coding. Falling into common E/M codin... Read more
Clip and Save:
Keep This CCI 20.3 Edits Table Handy to Help Make Your E/M Coding More Efficient
Knowing when you can use a modifier to seek separate E/M payment will add dollars to you... Read more
In the Vol. 2, No. 10 issue of the E/M Coding Alert, the article titled “Get to Kn... Read more
Reader Question:
Use Consult Info in Your MDM
Question: Our gastroenterologist consulted with a patient that was referred to her ... Read more
Reader Question:
30-Day TCM is the Key to E/M
Question: An 84-year-old female patient of ours who experienced congestive heart fa... Read more
Reader Question:
Identify Patient as Established for 99231-99233
Question: On a recent claim, I used a CPT® code for subsequent hospital care to... Read more
You Be the Coder:
Admission Status Helps You Determine E/M
Question: A patient at 38 weeks gestation presented to her ob-gyn office saying her... Read more
Key Elements:
Avoid 5 Common E/M Errors With These Expert Tips, Part 1
Find out why under-coding is just as bad as over-coding. No matter how many years or e... Read more
CMS Payment Policy:
Watch for 0-Day Global Periods on All Codes, CMS Says
You may be paid individually for all the services performed in the global period. CMS ... Read more
Pediatric Critical Care:
Implement the Updated 99466-99467 Reporting Guidelines
The ‘by land, air, or water’ place of service code is necessary for a comple... Read more
Reader Question:
Trust Your Choice of 99318 with Annual NF E/M
Question: My physician performed an annual E/M for her NF patient. She reviews the ... Read more
Reader Question:
Use 99253 When Payer Accepts Consult Codes
Question: Our vascular surgeon performed an inpatient consultation for acute ischem... Read more
Reader Question:
Keep an Eye on Chronic Care Payment Rate
Question: What is the final rule from CMS on the payment rate change for care manag... Read more
Reader Question:
Report Office and OR E/M on Same Day
Question: Our physician saw a one-year-old established patient that fell out of a s... Read more
You Be the Coder:
Pair Up Immunotherapy with E/M Service
Question: My pulmonologist assessed a patient suffering from severe pain and fever ... Read more
CPT® 2015:
Get to Know Next Year's Chronic Care Management Code Changes
A new code allows reimbursement for CCM non-face-to-face time. If you have been wonder... Read more
Mark Your 2015 Calendar for New ICD-10 Release Date
Use this time to test your systems to eliminate pain later. Whether you’re ... Read more
Inpatient Coding:
Determine When and What to Charge with a DOA
Don’t miss out on reimbursement by not reporting 99238. Whether or not you are a... Read more
Otolaryngology Spotlight:
Uncover When E/M Code Goes Hand in Hand with Coding Cerumen Removal
Separate the E/M from 69210 with modifier 25 to get deserved dollars. When your provid... Read more
Reader Question:
Decipher Notes to Code the Accurate Level
Question: An established 22-year-old male patient was seen and our physician docume... Read more
Reader Question:
Look Closely at the HEM to Pick 99201 or 99202
Question: After my physician performed a problem-focused history and examination on... Read more
Reader Question:
Don't Mix Related E/Ms During Global Periods
Question: We have a patient that had surgery with a 90-day global period on July 4.... Read more
Reader Question:
Separate Primary Visit from Prolonged Service
Question: During a scheduled office visit of a new patient, our cardiologist spent ... Read more
You Be the Coder:
Forms to Complete? Consider 99080 with an Office Visit
Question: My physician completed forms relating to the Family and Medical Leave Act... Read more
Correct Coding Initiative:
Update Your 99201-99215 Coding, Thanks to CCI 20.2
You can exhale: Modifier indicator “1” outnumbers “0” on E/M bun... Read more
Quick Quiz Answers:
Challenge Yourself With 3 Global Surgery Package Answers
Take charge of your E/M training and evaluate yourself. Your E/M education is ongoing,... Read more
Billing Spotlight:
Get Comfortable with Unruly Consolidated Billing Rules
Uncover who, what, and when to bill so you get your money. Knowing whether your skille... Read more
Picture This Example of Consolidated Billing
Knowing the patient’s residence status will prevent denials. A physician sees... Read more
Reader Question:
Break Up 99363 and 99364 in Anticoagulant Management
Question: We have a patient that comes into the office and requires anticoagulant m... Read more
Reader Question:
Prove Medical Necessity for 11721 with 99213
Question: Can I bill Medicare for an E/M visit (99213) along with a debridement of ... Read more
You Be the Coder:
Question Coding 99420 Separately From E/M
Question: A patient of one of our providers came in for an annual wellness visit an... Read more
News You Can Use:
Calculate HEM with Less Effort, Thanks to Guidelines Change
Remember the exam is the last criterion that differs from 1995 to 1997 guidelines. CMS... Read more
Clarify the HPI Guidelines Change with an Example
Break down your options and see which gives you highest code level. With the new Me... Read more
Quick Quiz:
Challenge Yourself with 3 Global Surgery Package Questions
Take charge of your E/M training and evaluate yourself. Understanding how the post-ope... Read more
Hospital Inpatient:
Don't Fret, 99221-99223 Replace Consult Codes
Adopt modifier AI when there’s more than one initial care performed. Because, as... Read more
Reader Question:
Code to Reflect the Extent of the Physician Discussion
Question: We have patients provide their chief complaint/reason for visit, history ... Read more
Reader Question:
Sharing Services in Global Period Means Share the Pay
Question: A physician of mine diagnosed a hip fracture and performed the surgery he... Read more
Reader Question:
Give a Reason for Interpretation #2
Question: I work in a new ob-gyn practice with a new provider/specialty: a urogynec... Read more
You Be the Coder:
Consider Including Telephone E/M in History or MDM
Question: We have a new patient that called his physician to discuss his visit that... Read more
Prolonged Services:
Focus on 3 Tips to Capture Deserved Extra Pay With +99354-+99357
Multiply your reimbursement by ensuring your physicians are using their watch to note ac... Read more
Nursing Facility Coding:
Understand and Separate "Initial" From "Subsequent" Care When Coding
Better your chances for a proper reimbursement by having the correct POS. When your ph... Read more
Newborn Care Services:
Cut Down on Errors by Separating Newborn From Sick Codes
Use just one diagnosis code with a normal newborn CPT®. Birth through 28 days is t... Read more
Reader Question:
Untangle the Encounter Details to Code a Pre-Op Clearance
Question: A Medicare patient came in to see our pulmonologist to get clearance for ... Read more
Reader Question:
Tread Carefully When Coding Follow-up Visits
Question: I read your article titled “Consider the Facts to Determine Fractur... Read more
Reader Question:
Skip 99397 for Medicare
Question: We have a 70-year-old patient that came in for a reevaluation and managem... Read more
Reader Question:
1 Patient + 2 issues + 1 Visit = 1 E/M
Question: A patient came in to our office complaining she had postnatal depression.... Read more
You Be the Coder:
Consider the Need to Administer Medication When Coding 99211
Question: We have a patient in our practice that comes in for her prothrombin time ... Read more
Global Periods:
Wrap Your Arms Around What Global Surgical Packages Mean to E/M
Receive separate payment when conditions allow. Knowing the number of post-operative d... Read more
News You Can Use:
Bill Signed into Law Delays Your Pay Cuts and ICD-10 Implementation
Experts hope that a long-term solution to the SGR formula will be secured. The Protect... Read more
Specialty Focus -- Orthopedic:
Consider the Facts to Determine Fracture Care or a Possible E/M
Hold on to your $ when choosing a fracture or casting code. When your physician sees a... Read more
Reader Question:
Track Post-Op Visits With 99024
Question: One of the doctors in our group saw a new patient in the emergency room f... Read more
Reader Question:
Make a Call to the Payer to Determine Whether E/M is Bundled With Surgery
Question: We had a patient present to the office for a relatively minor problem. Ou... Read more
Reader Question:
Use 99499 When a Service Doesn't Reflect a Code Description
Question: Can I use modifier 52 on 99201 if my provider only captures history and M... Read more
You Be the Coder:
Ask Payer For Preferred Consult Code
Question: When I use 99283 and 99284 I constantly get denied by my payer. My doctor... Read more
Correct Coding Initiative:
Dive Into the CCI 20.1 Edits and Ward Against Rejected Claims
New E/M bundles concentrate on clinical immunology. You’ll have to add a slew of... Read more
Quiz Answers:
Grade Yourself to See If You Can Avoid Critical E/M Errors
Hone your E/M skills with the answers to the quiz from last month’s issue. If yo... Read more
Be More Specific With Two Child Health Exam Codes
Splitting V20.2 in two allows with and without abnormal findings. When ICD-9 is replac... Read more
ICD-10 Delayed Another Year
As of Tuesday, April 1, President Obama signed the Protecting Access to Medicare Act of ... Read more
Reader Question:
No Modifier When E/M is Months Prior to Injection
Question: If a doctor injects a high-end injectable such as Synvisc, Hyalgan, Ortho... Read more
Reader Question:
Avoid Duplicating E/M Services
Question: We had a 44-year-old come in to see her physician for her wellness visit ... Read more
You Be the Coder:
Back Up and Master E/M Levels of Service
Question: Does an extended HPI guarantee a higher-level E/M code? Washington Subs... Read more
Inpatient Coding:
Be Aware of the New Inpatient Definition or Face Denials
Expect exceptions when using the “two-midnight” rule.  In the updated... Read more
Preventive Services:
Nab Separate Pay for Preventive and Problem-Oriented Visits with These Tips
Beware: Coding preventive medicine encounters as problem visits is a problem. When a p... Read more
Quick Quiz:
Test Yourself to Avoid These Critical E/M Errors
Use this quiz to identify where you need to focus your learning. One of the most effic... Read more
Outpatient E/M:
Embrace 99211 Regulations to Avoid Losing $20 per Encounter
Turn thorough documentation into successful claims. Evaluations of established patient... Read more
Reader Question:
Giving a Helping Hand Is a Shared Service
Question: My physician and a physician’s assistant visited the same patient i... Read more
Reader Question:
Master Coding Within Global Period
Question: One of the surgeons in my practice had a patient make an appointment to c... Read more
Reader Question:
Focus on Level of Physician Involvement For Incident To
Question: My physician has a patient that requires anti-coagulation monitoring in t... Read more
Reader Question:
Separating E/M From NCS Requires HEM
Question: Is it appropriate to bill an E/M in addition to a nerve conduction study ... Read more
You Be the Coder:
Emergency vs. Critical
Question: One of the physicians in my office went to the emergency department to me... Read more
Mind Your Modifiers:
Save Time By Understanding When to Use Modifier 57
Knowing why a claim with modifier 57 is denied, may help your appeal.  Modifier ... Read more
Things for you to remember about modifier 57
Use for E/M services only. Use when an E/M service results in a surgery. Make... Read more
Hospital E/M:
Follow These 5 Steps and Become a Pro With Subsequent Hospital Care Coding
Practicing each of these steps may increase your practice’s reimbursement. If y... Read more
Reader Question:
Gotta Have That HEM
Question: A patient came into the office to see our orthopedist to receive a knee inject... Read more
Reader Question:
Review New Patient Definition
Question: A patient came in to see our general surgeon in December and had a unilateral ... Read more
Reader Question:
Reporting Physician Procedure Subspecialty Avoids Denial
Question: We are in a large GI group all under the same tax ID.  One of our physici... Read more
Reader Question:
'Unable to Communicate' Caveat Only Applies to History
Question: I need help with the E/M for a patient with dementia. The patient took a fall ... Read more
You Be the Coder:
Be Sure to Hit 8 With Observation Coding
Question: My physician saw a patient in observation status but discharged the patient be... Read more
Hospital E/M:
Follow 5 Tips for Solid Discharge Service Coding
Time isn’t the only key to correctly using 99238-99239. With only two codes to p... Read more
Specialty Focus - Internal Medicine:
Skipping Tests, Screenings With Preventive Medicine Codes Will Cost Your Practice Hundreds
Pay attention to modifier 25 requirements to help ensure payment. You know that you sh... Read more
Rejoice In Conversion Factor Increase Rather Than Decrease
Hope for additional changes before the end of March. Like most practices, you were pro... Read more
CPT® 2014:
Check CPT® Errata for 'Qualified Health Care Professional' Clarification
Update your 2014 manual to reflect the changes. The AMA has updated its 2014 (and 2013... Read more
Reader Question:
New CMS-1500 Coming Soon
Question: How will the CMS 1500 form change to allow ICD-10-CM reporting? Vermont Subs... Read more
Reader Question:
Patient 'Coding' Doesn't Automatically Mean 99291
Question: After a patient with chest pain “coded” in the ER and was admitted... Read more
Reader Question:
Physicians Can't Bill Incident to Each Other
Question: I have a case where one physician (physician A) in my practice covered an esta... Read more
Reader Question:
Ensure Face-to-Face Counseling for 99407 with 99213
Question: I am billing 99407 with 99213 and getting denials. I have used the modifier 25... Read more
You Be the Coder:
Separate Hospital Stay -- 99468 or 99469?
Question: Our pediatrician admits a newborn baby with severe respiratory distress and we... Read more
Diagnosis Coding:
Scour the Documentation for a Solid Diagnosis When Your Provider Forgets to Pick One
When in doubt, go back to your provider for details. At some point, a superbill will c... Read more
Quick Quiz:
Evaluate Your Own E/M Coding Skills With 3 Test Questions
Test your skills with these questions to see where you should focus your E/M education. ... Read more
January Will Bring a 24.4 Percent Pay Cut Unless Congress Steps In
Good news: If you do chronic care management, watch for pay on non-face-to-face services... Read more
Reader Question:
2 Surgeons, 1 Practice = 1 Code on Same Day
Question: Two neurosurgeons in our practice treated a post-trauma patient twice on the s... Read more
Reader Question:
Medication Isn't the Only Factor in E/M Level
Question: Since prescription management involves moderate risk on the CMS standard docum... Read more
Reader Question:
Define 'Calendar Date' For Proper Billing
Question: The CPT® surgery guidelines state that the surgical package includes &ldqu... Read more
You Be the Coder:
Coding for 911 Call
Question: One of our patients presented for a sick visit but was so ill that the physica... Read more